急性肠系膜上静脉血栓形成病人临床特点及近期预后影响因素研究

李任重; 余培; 张鹏

doi:10.13898/j.cnki.issn.1000-2200.2020.02.021

急性肠系膜上静脉血栓形成病人临床特点及近期预后影响因素研究

Analysis of the clinical characteristics and influencing factors of short-term prognosis in 67 patients with ASMVT

摘要

摘要:
目的分析急性肠系膜上静脉血栓形成（acute superior mesenteric venous throwbosis，ASMVT）病人的临床特点及近期预后影响因素，为改善病人预后提供参考依据。
方法回顾性分析2004-2016年收治的67例ASMVT病人的基线资料，比较不同治疗方式与累及部位病人之间的临床特点，根据病人预后分为存活组与死亡组，通过单因素与多因素logistic回归分析法分析影响病人预后的相关因素。
结果67例ASMVT病人死亡8例，存活59例，死亡率11.94%；孤立型ASMVT组腹膜刺激征、开腹手术、肠坏死比例明显高于联合型ASMVT组，脾切除术比例低于联合型ASMVT组（P < 0.05~P < 0.01）；开腹手术组孤立型ASMVT比例、死亡比例均明显高于介入治疗组（P < 0.01）；介入治疗组发病至治疗时间均明显高于开腹手术组和保守治疗组（P < 0.01）；脾切除术、肝硬化脾亢、重症胰腺炎、静脉血栓史、发病至治疗时间、抗凝治疗时间 < 6个月、累及部位、肠坏死对ASMVT病人预后有明显影响（P < 0.05~P < 0.01）；脾切除术、肝硬化脾亢、重症胰腺炎、抗凝治疗时间 < 6个月为ASMVT病人死亡的独立危险因素（P < 0.05~P < 0.01）。
结论脾切除术后容易出现联合型ASMVT，孤立型ASMVT病人开腹手术、肠坏死以及腹膜刺激征比例较高；脾切除术、肝硬化脾亢、重症胰腺炎、抗凝治疗时间 < 6个月是影响ASMVT病人近期预后的主要因素。

Abstract:
ObjectiveTo analyze the clinical characteristics and influencing factors of short-term prognosis in 67 patients with acute superior mesenteric venous thrombosis(ASMVT) for providing the reference in improving the prognosis of patients.
MethodsThe baseline data of 67 patients with ASMVT in our hospital from 2004 to 2016 were retrospectively analyzed.The clinical features among the patients with different treatment methods and lesion locations were compared.The patients were divided into the survival group and death group according to the prognosis, and the prognostic factors were analyzed using the univariate and multivariate logistic regression method.
ResultsAmong 67 cases with ASMVT, 8 cases died, and 59 cases survived.The ratios of peritoneal irritation, laparotomy and intestinal necrosis in isolated ASMVT group were significantly higher than that in combined ASMVT group(P < 0.05 to P < 0.01).The ratios of splenectomy in isolated ASMVT group were lower than that in combined ASMVT group(P < 0.05).The ratios of isolated ASMVT and death in open surgery group were significantly higher than those in interventional therapy group(P < 0.01).The time from onset to treatment of interventional therapy group was significantly higher than that in open surgery group and conservative treatment group(P < 0.05 to P < 0.01).The splenectomy, liver cirrhosis, hypersplenism, severe pancreatitis, venous thrombosis history, time from onset to treatment, duration of anticoagulant therapy less than 6 months, lesion location and intestinal necrosis could obviously affect the prognosis of patients with ASMVT(P < 0.05 to P < 0.01).The splenectomy, liver cirrhosis, hypersplenism, severe pancreatitis and duration of anticoagulant therapy less than 6 months were the independent risk factors of death in patients with ASMVT(P < 0.05 to P < 0.01).
ConclusionsThe combined ASMVT is easy to be found after splenectomy, and the ratio of open surgery, intestinal necrosis and higher peritoneal irritation in isolated ASMVT patients are high.The splenectomy, liver cirrhosis, hypersplenism, severe pancreatitis and duration of anticoagulant therapy less than 6 months are the main influencing factors of prognosis in patients with ASMVT.

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