Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg Venous Lymphat Disord. 2020 Sep;8(5):748-755. doi: 10.1016/j.jvsv.2020.01.007. Epub 2020 Mar 3.
Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2).
This was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ test.
There were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12-12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104).
A genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.
肠系膜上静脉血栓形成（MVT）是一种尚未被充分了解的临床病症，因此其预后描述也不充分。本研究旨在确定 MVT 后发生肠缺血的预测因素，并比较接受内科治疗（第 1 组）与接受肠切除术治疗（第 2 组）的患者的结局。
这是一项回顾性单中心研究，纳入了 2008 年至 2018 年期间计算机断层扫描成像诊断为有症状的急性 MVT 的所有患者。纳入的变量包括人口统计学特征、合并症、影像学表现、实验室检查值和治疗方法。通过单因素和多因素统计学分析来确定肠切除术的预测因素。采用卡方检验比较死亡率、因腹痛再入院率和慢性肠系膜静脉充血等结局。
本研究共纳入 121 例患者；98 例患者接受内科治疗（第 1 组），19 例患者接受肠切除术治疗（第 2 组），4 例患者接受血管内再通治疗（第 3 组）。第 1 组和第 2 组直接进行比较。需要行肠切除术的患者倾向于具有更高的体重指数（P=.051）和易栓症（P=.003）。需要行肠切除术的患者更有可能出现乳酸酸中毒（P<0.001）和白细胞增多（P<0.001），且肠壁增厚（P<0.001）。多变量分析显示，遗传性血栓形成倾向是肠缺血的强烈预测因素（比值比，3.81；95%置信区间，1.12-12.37）。两组患者的 1 年死亡率和再入院率无差异。然而，两组患者的腹痛再入院率均较高（第 1 组，44.90%；第 2 组，57.89%；P=.317），且反复扫描显示有相当比例的患者存在慢性肠系膜静脉充血（第 1 组，42.86%；第 2 组，47.37%；P=.104）。
遗传性高凝状态是 MVT 导致肠缺血的预测因素。无论治疗方法如何，MVT 后的结局都很严重，腹痛再入院率很高。鉴于目前策略的不良结局，需要寻找一种替代方法来治疗这些患者。
