Hmoud Bashar, Singal Ashwani K, Kamath Patrick S
Department of Internal Medicine, UTMB, Galveston, TX, USA.
Division of Gastroenterology and Hepatology, UAB, Birmingham, AL, USA.
J Clin Exp Hepatol. 2014 Sep;4(3):257-63. doi: 10.1016/j.jceh.2014.03.052. Epub 2014 Apr 13.
Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival.
肠系膜静脉血栓形成越来越被认为是肠系膜缺血的一个原因。急性血栓形成通常表现为腹痛，慢性型则具有门静脉高压的特征。腹部增强CT扫描在诊断和鉴别两种类型的肠系膜静脉血栓形成方面相当准确。血栓前状态、血液系统恶性肿瘤和局部腹部炎症性疾病是常见的易感因素。在过去十年中，JAK-2（Janus激酶2）突变已成为诊断骨髓增殖性肿瘤的一种准确生物标志物，骨髓增殖性肿瘤是肠系膜静脉血栓形成的一个重要原因。抗凝是急性肠系膜静脉血栓形成的首选治疗方法。使用全身或经导管途径进行溶栓是另一种选择。有腹膜体征或对初始治疗措施无效的患者需要进行手术探查。对肠系膜静脉血栓形成的认识不断提高以及使用抗凝治疗导致手术需求减少，生存率得到改善。
