Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain.
Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain.
J Vasc Surg Venous Lymphat Disord. 2023 Jul;11(4):731-740. doi: 10.1016/j.jvsv.2023.02.006. Epub 2023 Mar 9.
Mesenteric venous thrombosis (MVT) is a rare cause of acute surgical abdomen, with high mortality. The aim of this study was to analyze long-term outcomes and possible factors influencing its prognosis.
All patients who underwent urgent surgery for MVT from 1990 to 2020 in our center were reviewed. Epidemiological, clinical, and surgical data; postoperative outcomes; origin of thrombosis; and long-term survival were analyzed. Patients were divided into two groups: primary MVT (hypercoagulability disorders or idiopathic MVT) and secondary MVT (underlying disease).
Fifty-five patients, 36 (65.5%) men and 19 (34.5%) women, mean age 66.7 years (standard deviation: ±18.0 years), underwent surgery for MVT. Arterial hypertension (63.6%) was the most prevalent comorbidity. Regarding the possible origin of MVT, 41 (74.5%) patients had primary MVT and 14 (25.5%) patients had secondary MVT. From these, 11 (20%) patients had hypercoagulable states, 7 (12.7%) had neoplasia, 4 (7.3%) had abdominal infection, 3 (5.5%) had liver cirrhosis, 1 (1.8%) patient had recurrent pulmonary thromboembolism, and 1 (1.8%) had deep venous thrombosis. Computed tomography was diagnostic of MVT in 87.9% of the cases. Intestinal resection was performed in 45 patients due to ischemia. Only 6 patients (10.9%) had no complication, 17 patients (30.9%) presented minor complications, and 32 patients (58.2%) presented severe complications according to the Clavien-Dindo classification. Operative mortality was 23.6%. In univariate analysis, comorbidity measured by the Charlson index (P = .019) and massive ischemia (P = .002) were related to operative mortality. The probability of being alive at 1, 3, and 5 years was 66.4%, 57.9%, and 51.0%, respectively. In univariate analysis of survival, age (P < .001), comorbidity (P < .001), and type of MVT (P = .003) were associated with a good prognosis. Age (P = .002; hazard ratio: 1.05, 95% confidence interval: 1.02-1.09) and comorbidity (P = .019; hazard ratio: 1.28, 95% confidence interval: 1.04-1.57) behaved as independent prognostic factors for survival.
Surgical MVT continues to show high lethality. Age and comorbidity according to the Charlson index correlate well with mortality risk. Primary MVT tends to have a better prognosis than secondary MVT.
肠系膜静脉血栓形成（MVT）是一种罕见的急性外科腹痛原因，死亡率很高。本研究旨在分析其长期预后，并探讨可能影响其预后的因素。
回顾性分析 1990 年至 2020 年期间在我院因 MVT 行急诊手术的所有患者。分析流行病学、临床和手术数据、术后结局、血栓形成的起源以及长期生存情况。患者分为两组：原发性 MVT（高凝状态或特发性 MVT）和继发性 MVT（基础疾病）。
55 例患者中，男 36 例（65.5%），女 19 例（34.5%），平均年龄 66.7±18.0 岁。动脉高血压（63.6%）是最常见的合并症。关于 MVT 的可能病因，41 例（74.5%）患者为原发性 MVT，14 例（25.5%）患者为继发性 MVT。其中，11 例（20%）患者存在高凝状态，7 例（12.7%）患者患有肿瘤，4 例（7.3%）患者存在腹部感染，3 例（5.5%）患者存在肝硬化，1 例（1.8%）患者存在复发性肺栓塞，1 例（1.8%）患者存在深静脉血栓形成。87.9%的病例通过计算机断层扫描诊断为 MVT。由于缺血，45 例患者行肠切除术。仅有 6 例（10.9%）患者无并发症，17 例（30.9%）患者出现轻微并发症，32 例（58.2%）患者出现严重并发症（Clavien-Dindo 分级）。手术死亡率为 23.6%。在单因素分析中，Charlson 指数（P=0.019）和大面积缺血（P=0.002）测量的合并症与手术死亡率相关。1、3、5 年的生存率分别为 66.4%、57.9%和 51.0%。在生存的单因素分析中，年龄（P<0.001）、合并症（P<0.001）和 MVT 类型（P=0.003）与良好预后相关。年龄（P=0.002；风险比：1.05，95%置信区间：1.02-1.09）和合并症（P=0.019；风险比：1.28，95%置信区间：1.04-1.57）是生存的独立预后因素。
手术治疗 MVT 仍然显示出较高的致死率。根据 Charlson 指数的年龄和合并症与死亡率风险密切相关。原发性 MVT 倾向于比继发性 MVT 有更好的预后。
