腸繫膜靜脈栓塞

10.6666/ClinMed.2017.80.1.072

林進偉；邱柏齊

腸繫膜靜脈栓塞(mesenteric venous thrombosis) ； 急性腸缺血(acute mesenteric ischemia) ； 透壁性腸梗塞(transmural bowel infarction)

臨床醫學月刊

80卷1期（2017 / 07 / 28）

382 - 388

繁體中文

本文以一案例報告為引子，探討腸繫膜靜脈栓塞此一腹部急症。血液高凝狀態、血管內膜受傷與靜脈血鬱積等因素促使腸繫膜靜脈血栓形成，造成腸缺血。急性期之早期表現以腹痛為主，伴隨非特異性症狀與理學檢查時不成比例之壓痛，不易早期診斷。目前診斷方式多以腹部電腦斷層為主。抗凝血劑是主要的內科治療藥物。血管腔內血栓溶解藥物滴注可使血管再通暢。若無法早期診斷，則可能併發透壁性腸梗塞、腸穿孔、腹膜炎或敗血症，而需採行手術治療。過去此疾病死亡率高，隨著診斷工具與治療方式的進步，近年死亡率已有下降之趨勢。

1. Acosta, S,Alhadad, A,Ekberg, O(2009).Findings in multi-detector row CT with portal phase enhancement in patients with mesenteric venous thrombosis.Emerg Radiol,16,477-482.
2. Acosta, S,Alhadad, A,Svensson, P(2008).Epidemiology, risk and prognostic factors in mesenteric venous thrombosis.Br J Surg,95,1245-1251.
3. Ageno, W,Dentali, F,Squizzato, A(2014).How I treat splanchnic vein thrombosis.Blood,124,3685-3691.
4. Ageno, W,Riva, N,Schulman, S(2015).Long-term Clinical Outcomes of Splanchnic Vein Thrombosis: Results of an International Registry.JAMA Intern Med,175,1474-1480.
5. Alvi, AR,Khan, S,Niazi, SK(2009).Acute mesenteric venous thrombosis: improved outcome with early diagnosis and prompt anticoagulation therapy.Int J Surg,7,210-213.
6. Brandt, LJ,Boley, SJ(2000).AGA technical review on intestinal ischemia.American Gastrointestinal Association. Gastroenterology,118,954-968.
7. Harnik, IG,Brandt, LJ(2010).Mesenteric venous thrombosis.Vasc Med,15,407-418.
8. Hedayati, N,Riha, GM,Kougias, P(2008).Prognostic factors and treatment outcome in mesenteric vein thrombosis.Vasc Endovascular Surg,42,217-224.
9. Kumar, S,Sarr, MG,Kamath, PS(2001).Mesenteric venous thrombosis.N Engl J Med,345,1683-1688.
10. Lee, SS,Ha, HK,Park, SH(2008).Usefulness of computed tomography in differentiating transmural infarction from nontransmural ischemia of the small intestine in patients with acute mesenteric venous thrombosis.J Comput Assist Tomogr,32,730-737.
11. Liu, FY,Wang, MQ,Fan, QS(2009).Intervention altreatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis.World Journal of Gastroenterology,15,5028-5034.
12. Schoots, IG,Koffeman, GI,Legemate, DA(2004).Systematic review of survival after acute mesenteric ischaemia according to disease aetiology.Br J Surg,91,17.
13. Singal, AK,Kamath, PS,Tefferi, A(2013).Mesenteric venous thrombosis.Mayo Clin Proc,88,285-294.
14. Vietti Violi, N,Fournier, N,Duran, R(2014).Acute mesenteric vein thrombosis: factors associated with evolution to chronic mesenteric vein thrombosis.AJR Am J Roentgenol,203,54-61.
15. Yang, S,Fan, X,Ding, W(2015).Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience.Thromb Res,135,36-45.
16. Yang, S,Liu, B,Ding, W(2015).Acute superior mesenteric venous thrombosis: transcatheter thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery in eight patients.Cardiovasc Intervent Radiol,38,88-99.
17. Yang, S,Zhang, L,Liu, K(2016).Postoperative Catheter-Directed Thrombolysis Versus Systemic Anticoagulation for Acute Superior Mesenteric Venous Thrombosis.Ann Vasc Surg,35,88-97.
18. Yang, SF,Liu, BC,Ding, WW(2014).Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis.World J Gastroenterol,20,5483-5492.