| Objective Taking the patients diagnosed with acute mesenteric venous thrombosis(AMVT)in the People's Hospital of Tibet Autonomous Region as the research object,the clinical manifestations,diagnosis and treatment were retrospectively analyzed,and the characteristics of the disease were summarized to deepen the clinician's The understanding of the disease provides a theoretical reference for selecting appropriate treatment methods and reducing the mortality and disability caused by the disease.Method A retrospective analysis of 56 patients with acute superior mesenteric venous thrombosis diagnosed by imaging or intraoperative imaging in the People's Hospital of Tibet Autonomous Region from 2012 to2018 was divided into anticoagulant therapy group and surgical treatment group according to the patient's treatment.Twenty patients in the treatment group and 36 in the surgical group were enrolled.The gender,age,BMI,duration of symptoms,early modified risk score(EWAS score),length of hospital stay,clinical presentation at admission,vital signs,and laboratorywere collected.Examination,imaging examination,US anesthesia risk classification(ASA classification),surgical procedure,operation time,length of intestinal necrosis,and postoperative complications.The differences between the general conditions and related observations of the two groups of patients were compared.Result Twenty-five of the 56 patients with AMVT(35.71%)underwent anticoagulant therapy.Two patients died after anticoagulant therapy,36patients(64.28%)underwent surgical treatment,and six patients died after surgery.The cause of death is mostly multiple organ failure(MODS).The duration of symptoms in the surgical group was longer than that in the anticoagulation group.The white blood cell count,hemoglobin,and D-dimer in the laboratory were higher than those in the anticoagulation group.The difference was statistically significant(P <0.05).The average operation time of the surgical treatment group was 180(150,360)min,the longest operation time was 360 min,the shortest time was 100 min,and 33 cases(58.93%)of intra-abdominal ascites,13 of which(23.21%)were purulent ascites,20Example(35.71%)is bloody ascites.During the operation,the small intestine was resected 200(150,300)cm,the longest intestine was removed 300 cm,and the shortest resection was 15 cm.One of them(1.79%)was completely resected.In the operation,9 patients(25%)underwent stage I anastomosis and 27(75%)underwent sputum.In the anastomosis group,there were 2cases of anastomotic leakage,1 case of disseminated intravascular coagulation(DIC),2 cases of abdominal infection,3 cases of AKI,and 4cases of death.In the phlegm group,2 patients developed disseminated intravascular coagulation(DIC),4 patients developed acute renal impairment(AKI),1 patient had abdominal infection,and 2 patients died.Conclusion 1.According to the data,the acute mesenteric venous thrombosis is mainly male,the ratio of male to female is 11:3.Patients with no obvious signs of peritonitis and stable vital signs can be treated with anticoagulation when the abdominal signs are closely observed.Once the condition is aggravated,prepare for a laparotomy at any time.2.Through the data of this study,abdominal enhanced CT and angiography are the main methods for the diagnosis of such diseases.Laboratory examination of white blood cell count,neutrophil ratio,D-dimer can help evaluate the patient's condition.3.According to the data of this study,the postoperative complications and mortality of patients with acute mesenteric venous thrombosis with stage I anastomosis are higher than those of sputum.We believe that ostomy is a relatively safe surgical procedure.4.It is recommended to conduct EWAS scores for patients with acute abdominal pain,and to give sufficient attention to patients with a score of >5,and to include mesenteric ischemic disease routinely in differential diagnosis. |
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