摘要
目的探讨肝移植术中门静脉血栓切除技术的改进。方法回顾性分析天津市第一中心医院移植外科收治的合并门静脉血栓（PVT）的198例肝移植患者的临床资料，根据术中PVT的处理方法不同分为两组：A组为常规外翻式门静脉血栓切除术组（n=43），B组为不切断PVT的外翻式门静脉血栓切除术组（n=155）。分别比较两组患者术中一般情况、失血量、血栓切除成功率、PVT复发率及患者生存情况等指标。结果两组手术时问无明显差异（P〉0．05）。两组YerdelⅠ级及Ⅱ级患者血栓切除成功率均为100％；B组中Yerdel Ⅲ级患者血栓切除成功率较A组高（100％比45．4％；）（X^2=12．38，P〈0．01）。B组失血量较A组明显减少[（4315．4±630．5）ml比（3509．2±862．7）ml，P〈0．05]。B组YerdelⅠ～Ⅱ级PVT患者术后血栓复发率与A组相比差异无统计学意义（P〉0．05），而Yerdel Ⅲ级患者术后血栓复发率低于A组（5．6％比2／5；X^2=4．09，P〈0．05）；两组YerdelⅠ～Ⅲ级PVT患者围手术期病死率均为0，差异无统计学意义（P〉0．05）。两组YerdelⅠ～Ⅲ级PVT患者1年生存率的差异无统计学意义（86．5％比89．0％，P〉0．05）。结论不切断PVT的外翻式门静脉血栓切除术可以简化手术操作，减少术中出血量，扩大应用范围，提高血栓切除的成功率，降低术后血栓复发率。
Objective To discuss the technical improvement of the conventional thrombectomy for portal vein thrombosis（PVT） on liver transplantation. Methods The clinical data of 198 cases of liver transplantation with PVT who admitted in Tianjin First Central Hospital were analyzed retrospectively. According to the different treatments for PVT, these cases were divided into group A and group B. The conventional eversion embolectomy were performed in group A （n = 43 ） and the improved eversion embolectomy were performed in group B （ n = 155 ）, The general conditions, blood loss volumes, the achievement ratio of embolectomy, PVT recurrence rate and survival rate between the two groups were compared. Results No statistical significance on operation time between two groups （P 〉 0. 05 ）; the achievement ratio of embolectomy for Yerdel I -Ⅱ were 100% in two groups,however,the achievement ratio of embolectomy for Yerdel m in group B was higher than that of group A （ 100% vs. 45.45% ;X^2 = 12. 38, P 〈 0. 01 ）, Blood loss volumes in group B was significantly lower than that of group A [ （ 4315.4 ± 630. 5 ） ml vs. （3509.2 ± 862, 7） ml, P 〈 0. 05 ]. No statistical significance on Yerdel Ⅰ and Ⅱ PVT recurrence rate between two groups （P 〉 0. 05）. While thrombosis recurrent rate of Yerdel Ⅲ PVT in group B was lower than that of group A （5.6% vs. 2/5 ;X^2 =4.09,P 〈 0. 05 ）. Perioperative mortality of Yerdel Ⅰ- Ⅲ patients were both 0 in two groups. 1-year survival rate of Yerdel Ⅰ -Ⅲ patients was similar in two groups（86. 5% vs. 89.0%, P 〉 0. 05 ）. Conclusions Improved eversion embolectomy can simplify the operation procedures,reduce blood loss,expand application range,increase the embolectomy success rate, decrease the PVT relapse rate.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第22期1681-1684,共4页
Chinese Journal of Surgery
关键词
肝移植
静脉血栓形成
治疗
Liver transplantation
Venous thrombosis
Therapy
