摘要
目的总结肠系膜血管病变致消化道出血的临床诊治经验,提高此类疾病的早期诊断水平及临床疗效。方法回顾性分析2010年1月至2016年12月第三军医大学大坪医院野战外科研究所收治的37例肠系膜血管病变所致消化道出血患者的临床表现、诊断方法、治疗措施及疗效。结果肠系膜上动脉血管栓塞18例,肠系膜上动脉夹层动脉瘤11例,肠系膜下动脉血管栓塞3例,肠系膜上静脉血栓形成、狭窄4例,肠系膜下静脉血栓形成1例。18例患者肠镜均见结肠黏膜充血、肿胀、溃疡形成。行内科药物保守治疗患者21例;经血管介入治疗13例;外科手术治疗3例;1例患者因肠穿孔后合并感染性休克死亡,其余患者临床症状均完全改善。结论肠系膜血管病变致消化道出血多发生于合并伴有动脉硬化、心血管疾病、肝硬化、胰腺病史的患者,临床表现缺乏特异性,CT影像及血管重建技术在诊断中起到重要作用;早期诊断、合理抗凝及血管介入治疗尤为重要,多数患者预后良好。
Objective To summarize the clinical diagnosis and treatment of gastrointestinal bleeding caused by mesenteric vascular lesions, and to improve the early diagnosis and clinical curative effect of these diseases.Methods Medical records about clinical manifestation,diagnosis methods,treatment and curative effect of 37 patients with gastrointestinal bleeding caused by mesenteric vascular lesions in Daping Hospital,Third Military Medical University from Jan. 2010 to Dec. 2016 were collected,reviewed and analyzed retrospectively. Results There were 18 cases of superior mesenteric artery embolization,11 cases of superior mesenteric artery dissection aneurysm,3 cases of inferior mesenteric artery embolism,4 cases of superior mesenteric venous thrombosis and stenosis and 1 case of inferior mesenteric vein thrombosis. Colonic mucosal congestion,swelling and ulceration were observed in 18 patients. There were 21 cases of drug treatment,13 cases of intervention therapy,3 cases undergoing surgical treatment,1 patient died of septic shock caused by intestinal perforation,the symptoms of the other patients were completely improved. Conclusion Gastrointestinal bleeding caused by mesenteric vascular lesions happens to patients with atherosclerosis,cardiovascular disease,liver cirrhosis pancreas. Clinical manifestations were lack of specificity,CT imaging and vascular reconstruction technique play important roles in the diagnosis. Early diagnosis,reasonable of anticoagulant and vascular interventional treatment are particularly important,the prognosis of most patients is good.
出处
《胃肠病学和肝病学杂志》
CAS
2018年第1期66-69,共4页
Chinese Journal of Gastroenterology and Hepatology
关键词
肠系膜血管
消化道出血
抗凝治疗
血管介入治疗
Mesenteric vascular
Gastrointestinal bleeding
Anticoagulation
Vascular interventional treatment
