| Objective: Discuss the disease etiology, clinical manifestation, diagnosis and treatment methods, to understand the current situation,to improve the cognition to the disease,to reduce misdiagnosis rate and mortality. compare two thrombolytic therapy and its complications, discuss the intervention treatment effect by retrospectively analyzed. Method: Collect vascular surgery of shanxi dayi hospital in November 2011 to October 2015 were approved by peripheral venous thrombolysis treatment, and by the superior mesenteric artery thrombolysis treatment of MVT.selected 37 patients who have complete case data in the study area. 37 patients according to the different thrombolysis therapy were divided into two groups. I group included 16 patients with peripheral venous thrombolysis,II group of 21 patients with the superior mesenteric artery thrombolysis treatment.Analysis about the patients’ sex, age, cause, clinical manifestation, laboratory examination, imaging examination, diagnosis and the time of symptoms relief.Result: 1. The 37 MVT patients,23 were men and 14 were women,the men than women was 1.6:1.The yongest 15 years old, the oldest patients 76 years of age,the average(45.1±13.00) years old.2. The 37 MVT patients, Ten patients without obvious history of MVT. 27 cases of MVT induced relevant medical history, 9 cases of liver cirrhosis patients with portal hypertension and liver cancer patients in 1 case, four columns after splenectomy, 8 patients with always VTE, lack of protein C and protein S in 1 case, antithrombin III-lack of 2 cases, 4 patients with long-term oral estrogen, 1 case of pregnancy patients, patients with polycythemia vera disease in 1 case.3. The 37 patients with MVT with abdominal pain clinical manifestations, Since a clinical manifestation to see a doctor the average number of days(9.3±5.2) days, Periumbilical and upper abdomen, 28 cases(75.7%), lower abdominal pain in 3 patients(8.1%), 6 patients with abdominal pain(16.2%). abdominal distention 34 cases(91.9%), nausea, vomiting, 10 cases(72.9%), stop the exhaust and defecation 8 cases(22.2%), hematochezia 6 cases(16.2%), diarrhea(8.1%) in 3 cases.A preliminary diagnosis of 13 patients with clear,the first diagnostic misdiagnosed was 24 cases(64.9%).4. In 37 patients with MVT,The D-dimer rise in 34 cases(91.9%).30 cases given the doppler examination, 19(61.3%) cases had positive performance, and further perfect the abdomen CTA clear diagnosis, no false positive cases. 35 cases are in the Outside the hospital or our hospital given abdominal enhanced CT examination diagnosis, 2 given abdominal MRI diagnosis.5. Of 37 cases, given peripheral vein thrombolysis thrombolytic treatment of 16 cases, The the average time of pain symptoms obviously alleviate was(3.7±1.1) days, the average time of hospital stay in patients was(19.1±3.5) days, in the process of the treatment,4 cases with abdominal tenderness, rebound tenderness, abdominal peritonitis performance laparotomy surgery treatment, We can see necrotic bowel in the surgery, removal of necrotic bowel. By the superior mesenteric artery catheter thrombolysis 21 cases, The the average time of pain symptoms obviously alleviate was 2.0(2.0) days, the average time of hospital stay in patients was(20.3±4.7) day, asymptomatic gradually aggravate in the process of treatment, surgical treatment.No patients appeared cerebral hemorrhage, gastrointestinal bleeding complications such as bleeding in the two kinds different thrombolysis treatment. Through the statistical analysis that the average time of pain symptoms obviously get shorter by superior mesenteric artery thrombolysis shorten than by peripheral venous thrombolysis(P = 0.005 < 0.05) and the curative effect is more significant(P=0.028<0.05). There was no difference about the average time of hospital stay in the two kinds different thrombolysis treatment(P=0.412>0.05).Conclusions: 1. MVT is clinical rare diseases, because we often lack of awareness of the disease and the lack of specificity of clinical inspection laboratory examination and missed diagnosis and misdiagnosis, delay diagnosis and treatment. 2. Clinical common cause with blood stasis caused by cirrhotic portal hypertension, abdominal infection, some blood diseases such as polycythemia vera disease and high blood coagulation state that oral contraceptives, abdominal trauma and surgery. 3. Laboratory examination notice D-dimer screening, such as D-dimer increased significantly associated with severe abdominal pain and other clinical manifestations, should be vigilant attention to identify the disease. Enhanced CT and MRI diagnosis positive rate is higher, if patients have highly suspected MVT that should be used as the preferred examination. Colour Doppler can be used as a means of screening and review of the disease. 4. With the continuous development of interventional therapy for patients with MVT,we have more treatment options. The superior mesenteric artery thrombolysis therapy is batter about improve patients’ clinical symptoms than peripheral venous thrombolysis treatment, reduce the risk of open operation. |
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