Rieu Virginie, Ruivard Marc, Abergel Armand, Pezet Denis, Fouilhoux Alain-Charles, Tournilhac Olivier, Philippe Pierre
Fédération de Médecine Interne, Maladies Infectieuses et Hématologie Clinique., CHRU, Hôtel Dieu, Clermont-Ferrand.
Ann Med Interne (Paris). 2003 May;154(3):133-8.
Mesenteric venous thrombosis is uncommon. Diagnosis is difficult and much remains to be learned about clinical aspects, etiology and treatment options.
We conducted a retrospective study over 5 years concerning patients with isolated mesenteric venous thrombosis or with extension to the portal vein.
Twenty-three patients (12 women), mean age 55 years, were included. Abdominal pain (96%), bowel obstruction (35%), fever (26%), diarrhea (17%), gastrointestinal bleeding (13%) were the most common symptoms at presentation. In 78% of patients, at least one underlying condition was identified: thrombophilia, oral contraceptive, cancer, paroxysmal nocturnal hemoglobinuria, essential thrombocythemia, intra-abdominal processes. CT scan and ultrasound diagnostic sensitivity were 89% and 57% respectively. Outcome was favorable for the 18 patients treated with anticoagulants (associated with surgery in 4 patients). Three patients with neoplasm died early.
Mesenteric venous thrombosis must be kept in mind as a possible diagnosis in patients with abdominal pain. Predisposing factors are frequently associated and should be searched for. Early diagnosis, using CT scan or ultrasound, enables immediate anticoagulation and seems to improve outcome.
肠系膜静脉血栓形成并不常见。诊断困难，关于其临床特征、病因及治疗选择仍有许多有待了解。
我们对5年间孤立性肠系膜静脉血栓形成或血栓扩展至门静脉的患者进行了一项回顾性研究。
纳入23例患者（12例女性），平均年龄55岁。腹痛（96%）、肠梗阻（35%）、发热（26%）、腹泻（17%）、胃肠道出血（13%）是最常见的首发症状。78%的患者至少发现一种基础疾病：血栓形成倾向、口服避孕药、癌症、阵发性夜间血红蛋白尿、原发性血小板增多症、腹腔内病变。CT扫描和超声的诊断敏感性分别为89%和57%。18例接受抗凝治疗的患者预后良好（4例联合手术）。3例肿瘤患者早期死亡。
对于腹痛患者，必须考虑肠系膜静脉血栓形成这一可能诊断。常伴有易感因素，应予以查找。采用CT扫描或超声进行早期诊断，可立即进行抗凝治疗，似乎能改善预后。
