【摘要】 目的探讨伴有腹膜炎的急性肠系膜静脉血栓形成(MVT)的治疗策略。方法回顾性分析2010年1月至2015年6月收治的24例合并腹膜炎的急性MVT患者的临床诊治过程。患者首先采用肝素抗凝及禁食、胃肠外营养等保守治疗,对部分患者进行选择性的剖腹探查手术,观察住院期间保守治疗和手术患者的临床转归和结果。结果 24例患者中初始即接受手术治疗有4例,初始接受保守治疗有20例,后因保守治疗无效而改为手术治疗有3例。1例手术患者放弃治疗,自动出院。2例手术的患者术后发生短肠综合征,经治疗后营养情况稳定。全程均为保守治疗的17例患者症状、体征明显好转,顺利出院。结论合并腹膜炎的急性MVT可以通过抗凝等保守治疗取得良好效果,但应根据病情具体情况做出个体化决策,选择性进行手术探查。更多还原

【Abstract】 Objective To determine the treatment strategy for acute mesenteric venous thrombosis(MVT) in patients with peritonitis.Methods Outcomes of 24 consecutive patients suffering from acute MVT between January 2013 and June 2014 were evaluated.All patients with peritonitis received initial anticoagulation therapy and total parenteral nutrition,and some patients were selectively operated.Clinical outcomes of operative and non-operative patients were analyzed.Results Four patients underwent laparotomy immediately after anticoagulation on admission.Twenty patients received anticoagulation therapy and total parenteral nutrition,and 3 out of these 20 patients converted to operation when medcine treatment was ineffective.One operative patient gave up surgery and discharged after laparotomy.Two patients developed short bowel syndrome after small bowel resection and nutritional status was stable after treatment.Seventeen patients who were treated merely by medicine treatment recovered well and discharged uneventfully.Conclusion For acute MVT patients with peritonitis,anticoagulation is feasible and effective as an initial treatment,however,laparotomy should be individualized if necessary.更多还原