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題名 | Mesenteric Venous Thrombosis Due to Anti-thrombin Ⅲ Deficiency--Report of Two Cases=抗凝血酶-Ⅲ缺乏導致上腸繫膜靜脈栓塞--兩個病例報告 |
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作者姓名(中文) | 王志堂; 周燕輝; 歐陽資明; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 32:4 民88.07-08 |
頁次 | 頁181-185 |
分類號 | 416.264 |
關鍵詞 | 抗凝血酶Ⅲ缺乏; 腸繫膜靜脈栓塞; Mesenteric vein thrombosis; Anti-thrombin Ⅲ deficiency; |
語文 | 英文(English) |
中文摘要 | 臨床上要在手術前正確的診斷出上腸繫膜血管阻塞,往往有困難。大多數的患者都是在術中才發現到此種疾病。而腸繫膜靜脈栓塞引起腸子壞死並不常見,約佔所有腸繫膜血管缺血導致腸子壞死的10%。本文報告的二個病例在術前都是以腹膜炎進行手術,術中可見壞死小腸部份的腸繫膜動脈依然有脈動而靜脈血管內卻可見血栓。最後經由血液檢查證實為抗凝血酉每一III缺乏導致上腸繫膜靜脈栓塞。第一例為44歲男性,他過去的病史中有下肢靜脈栓塞導致皮膚潰傷而接受皮瓣移植手術。第二例為69歲男性,過去也曾經有下肢紅腫的現象。此與文獻上所述;病人多有下肢靜脈栓塞的病史相吻合。病例一患者術後只給予靜脈注射新鮮冷凍血漿並未馬上給予靜脈注射抗凝血劑,而是在術後反覆性的腹痛,接受上腸繫膜動脈攝影檢查時才給予靜脈注射抗凝血劑治療一天後改口服抗凝血劑繼續治療。病例二患者在術後馬上給予靜脈注射抗凝血劑治療,等患者能進食後再改成口服抗凝血劑繼續治療。二位病人在後續的治療中,至今都沒有靜脈栓塞的現象產生。 |
英文摘要 | Mesenteric venous thrombosis is an uncommon but distintct form of intestinal ischemia. In the past, most patients presented with an acute abdomen, and the diagnosis was made only at laparotomy. In this report we identify two cases of antithrombin III deficiency presenting with mesenteric vein thrombosis and bowel infarction. In case one, a 44-year-old male, developed gradually worsening abdominal pain. Laparotomy revealed peritonitis due to segmental small bowel infarction. The underlying pathologic condition of mesenteric vein thrombosis is suspected. Post-operation fresh frozen plasma is given. Anti-thrombin III deficiency is confirmed by blood study. The patient received intravenous heparin treatment after superior mesenteric artery angiographic examination because of post-operative repeating epigastric pain. Intravenous heparin is shifted to oral coumadin one day later. In case two, a 69-year-old male, receives exploratory laparotomy owing to peritonitis. A 22 cm section of jejunum infarction with mesenteric thrombosed veins and patent arteries are found. Intravenous heparin treatment is given promptly and anti-thrombin III deficiency is proved by blood study. The patient receives long-term coumadin treatment from 4th day postoperatively. |
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