摘要
目的:探讨脾切除术后门静脉系统血栓形成临床特征及治疗。方法:选取2010-06~2015-06我院普外科收治的因外伤脾破裂及肝硬变门静脉高压症采取脾切除术治疗,术后合并门静脉血栓形成的患者30例,设为观察组,选取同期同类手术未合并门静脉血栓形成的患者30例,设为对照组,观察两组相关指标,并回顾合并门静脉系统血栓形成患者诊治预后。结果:观察组术前门静脉直径、脾静脉直径较对照组均明显增粗,有统计学差异(P〈0.05)。观察组门静脉血流速度、脾静脉血流速度均小于对照组,有统计学差异(P〈0.05)。对照组术后均好转出院。观察组经抗凝溶栓干预1周后,血栓完全消除出院12例;抗凝溶栓2周,管腔部分再通出院7例,血栓完全消除出院10例;因腹膜炎症状加重,在溶栓治疗4d后出现多器官功能衰竭而死亡1例。结论:门静脉系统血栓形成与脾切除术后患者体内血流动力学改变及血小板升高相关,需重视手术医师操作的规范化,早期发现异常,行祛凝抗凝溶栓治疗,为有效防控方案。
Objective: To Study the clinical features and treatment of portal vein thrombosis after splenectomy.Method: 30 cases of postoperative patients with portal vein thrombosis from June 2010 to June 2015 in department of general surgery in our hospital for traumatic rupture of spleen and liver cirrhosis and portal hypertension adopted splenectomy were selected and divided into observation group and control group. 30 patients with operations during the same period not associated with portal vein thrombosis formation were divided into control group. The related index in two groups were observed. The merger of portal venous system thrombosis diagnosis and treatment and prognosis of patients were reviewed. Result: The diameter of portal vein and splenic vein in observation group were significantly increased compared with the control group( P〈0. 05). The blood flow velocity and blood flow velocity of the portal vein in the observation group were less than those in the control group( P〈0. 05). Control group were improved after surgery. In the observation group,after 1 weeks of treatment with anticoagulant thrombolysis,thrombosis of 12 cases completely eliminated. 2 cases of anticoagulation and thrombolysis,7 cases of partial discharge,10 cases of thrombosis completely eliminated,due to the increase of symptoms of peritonitis. 1 case multiple organ failure after thrombolytic treatment 4D. Conclusion: Portal venous system thrombosis and after splenectomy in patients with hemodynamic changes and platelet increased,which needs to pay attention to the standardization of the surgeon operation. Early detection of abnormalities and removing coagulation anticoagulation and thrombolysis is effective prevention and control programs.
出处
《黑龙江医药科学》
2016年第4期64-65,67,共3页
Heilongjiang Medicine and Pharmacy