摘要
目的探讨脾切除术后门静脉血栓形成(portal vein thrombosis,PVT)的原因、诊断和治疗。方法对我院2002年8月至2008年8月期间收治的因肝硬变门静脉高压症及外伤脾破裂行脾切除术后发现PVT的29例患者的临床资料进行回顾性分析。结果 29例PVT患者中27例经抗凝溶栓治疗后血栓完全或部分溶解吸收、康复出院;1例因腹膜炎、感染性休克和多器官功能衰竭死亡;1例因呕血、肝昏迷及多器官功能衰竭死亡。24例患者获随访,3例失访,随访时间0.5～3年,平均2年,其中2例因大出血死亡、1例因肝性脑病死亡、1例因肝功能衰竭死亡,2例于出院1年后发生下肢深静脉血栓,其余患者未再发生静脉血栓。结论 PVT与脾切除术后血小板升高及血流动力学改变有关,手术操作规范化、早期诊断以及抗凝祛聚是防治PVT的有效方法。
Objective To explore the cause, diagnosis, and treatment methods of portal vein thrombosis （PVT） after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweentyseven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis, septic shock, and multiple organ failure. One case died of hematemesis, hepatic coma, and multiple organ failure. Tweentyfour patients were followed up, the followup time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy, and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of operation, early diagnosis, early line anticoagulant, and antiplatelet adhesion therapy are effective way to prevent and treat PVT.
出处
《中国普外基础与临床杂志》
CAS
2012年第6期649-652,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肝硬变
脾切除术
门静脉血栓
Liver cirrhosis
Splenectomy
Portal vein thrombosis
