肠系膜上静脉血栓形成分为原发性和继发性2种。前者原因不明，发病率占10%～20%，这些病人中有曾患过周围静脉炎如游走性静脉炎等。后者常继发于：①肝硬化或肝外压迫引起门静脉充血和血液淤滞；②腹腔内感染如化脓性阑尾炎、盆腔炎、溃疡性结肠炎、绞窄性疝等；③某些血液疾病如真性红细胞增多症，以及口服避孕药等所致的高凝状态；④腹外伤或手术所致的创伤，如肠系膜血肿脾切除、右半结肠切除等，病情严重，往往伴有休克；⑤腹腔恶性肿瘤直接压迫阻断肠系膜静脉血流；⑥先天性凝血功能异常如遗传性抗凝血酶Ⅲ缺陷症、遗传性蛋白质C缺陷症、遗传性蛋白质S缺陷症等此种多见于年轻患者既往有深静脉血栓形成病史。约1/4的病人无明显诱因称为原发性肠系膜静脉血栓形成。
Drawing illustrates the normal mesenteric venous circulation. 1 =门静脉 portal vein, 2 =脾静脉 splenic vein, 3 =肠系膜上静脉 SMV, 4 =空回肠静脉 jejunal and ileal veins, 5 =回结肠静脉 ileocolic vein, 6 =右结肠静脉 right colic vein, 7 =中结肠静脉 middle colic vein, 8 =胰十二指肠静脉 pancreaticoduodenal veins, 9 =肠系膜下静脉 IMV, 10 =左结肠静脉 left colic vein, 11 =乙状结肠和直肠静脉 sigmoid and rectosigmoid veins, 12 =左右直肠上静脉 right and left superior rectal veins. (Courtesy of Philippe Clavel, Centre d’Enseignement Médical et de Communication Audiovisuelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.)
46岁 男 肠系膜上静脉血栓形成。增强CT图像显示肠系膜上静脉和脾静脉充盈缺损。
46-year-old man with superior mesenteric vein thrombosis. Contrast-enhanced CT image obtained cephalad to B shows thrombi in superior mesenteric vein (arrowhead) and splenic vein (arrow).
46岁,男,肠系膜上静脉血栓形成。增强CT图像显示肠系膜静脉怒张（箭头）和肠壁增厚。可见腹水。
46-year-old man with superior mesenteric vein thrombosis. Contrast-enhanced CT image shows engorgement of mesenteric veins (arrowhead) and mural thickening of intestine. Ascites is present.
轴位（a）和冠状MIP（b）多层CT增强影像显示弥漫性肠壁增厚（白色箭头）肠壁异常强化，有些肠袢强化减低（图a 黑色箭头），与肠梗塞一致；其他显示肠壁强化增加（图a 箭头）。“晕征”（图b 黑箭头）。门静脉和肠系膜上静脉肿胀，其内见充盈缺损（图b 直箭头），与血栓形成一致。肠系膜根部（图b 弯箭头）的小静脉怒张。肠系膜肿胀（图a f）和腹水（图b *）。
Axial (a) and coronal MIP (b) contrast material–enhanced multidetector CT images demonstrate diffuse circumferential bowel wall thickening (white arrowheads) with abnormal wall enhancement: Some bowel loops show decreased enhancement (black arrowheads in a), consistent with bowel infarction; others show increased enhancement (arrow in a). The “halo sign” (black arrowhead in b) is also present. A hypoattenuating venous filling defect with vein enlargement is seen in the portal vein and SMV (straight arrows in b), consistent with a thrombosis. There is venous engorgement in the small veins of the mesenteric root (curved arrow inb). Mesenteric fat edema (f) and ascites (* in b) are also noted.
63岁，男，肠系膜上静脉闭塞性血栓形成后腹痛进行性加重。经皮肝穿刺门静脉造影显示肠系膜上静脉闭塞，脾静脉和门静脉显示。
63-year-old man with progressively worsening abdominal pain after occlusive thrombosis of superior mesenteric vein. Percutaneous transhepatic portogram at portal confluence shows occluded superior mesenteric vein and patent splenic and portal veins.
http://www.ajronline.org/doi/full/10.2214/AJR.08.1138
http://pubs.rsna.org/doi/full/10.1148/rg.325115100?queryID=9%2F1721415
http://www.ajronline.org/doi/full/10.2214/ajr.181.5.1811305
重庆三峡中心医院放射科 李国铨
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