摘要目的 分析67例急性肠系膜上静脉血栓形成(ASMVT)患者的临床特点及近期预后影响因素,为改善患者预后提供参考依据.方法 回顾性分析67例ASMVT患者的基线资料,根据不同治疗方式、不同累及部位及不同预后分组,通过单因素与多因素Logistic回归分析法分析影响患者预后的相关因素.结果 67例ASMVT患者死亡8例,存活59例,病死率为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).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和保守治疗组,介入治疗纽发病至治疗时间、联合型ASMVT比例均明显高于开腹手术组和保守治疗组(P＜0.05).脾切除术、肝硬化脾功能亢进、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患者预后有明显影响(P＜0.05);脾切除术、肝硬化脾功能亢进、重症胰腺炎、抗凝治疗时间＜6个月为影响ASMVT患者预后的独立危险因素(P＜0.05).结论 脾切除术后容易出现联合型ASMVT,孤立ASMVT患者开腹手术比例、肠坏死以及腹膜刺激征较高;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患者近期预后的主要因素.

abstractsObjective To analyze the clinical characteristics and influence factors on short-term prognosis of 67 patients with acute superior mesenteric venous thrombosis (ASMVT),so as to provide reference for improving the prognosis of patients.Methods The baseline data of 67 patients with ASMVT were retrospectively analyzed;the patients were grouped according to the treatment modes,involved areas and prognosis;the influence factors of prognosis were analyzed with single factor analysis and binary logistic analysis.Results Among the 67 cases of patients with ASMVT,8 cases died,59 cases survived,and mortality was 11.94％;in isolated ASMVT group,ratios of peritoneal irritation,laparotomy,intestinal necrosis were significantly higher than those in combined ASMVT group,the ratio of splenectomy was lower than that in combined ASMVT group (all P ＜ 0.05);the proportion of isolated ASMVT in laparotomy group was significantly higher than that in interventional treatment group and conservative treatment group,incidence of combined ASMVT and time from onset to treatment were significantly higher in interventional treatment group than those in laparotomy group and conservative treatment group (all P ＜0.05);splenectomy,hypersplenism in cirrhosis,sever pancreatitis,history of venous thrombosis,onset to treatment time,duration of anticoagulant therapy ＜ 6 months,involved areas,intestinal necrosis had obvious influence on the prognosis of patients with ASMVT (P ＜ 0.05);splenectomy,hypersplenism in cirrhosis,severe pancreatitis,duration of anticoagulant therapy ＜ 6 months were independent prognostic factors in patients with ASMVT (P ＜ 0.05).Conclusions It prones to express combined ASMVT after splenectomy,and isolated ASMVT patients have high ratios of laparotomy,intestinal necrosis and peritoneal irritation;splenectomy,hypersplenism in liver cirrhosis,severe acute pancreatitis,duration of anticoagulant therapy ＜6 months are the main factors influencing the short-term prognosis of patients with ASMVT.