摘要
目的探讨外科手术治疗门静脉高压症合并门静脉血栓(portal vein thrombosis,PVT)患者上消化道出血的疗效.方法14例术前存在P V T患者与32例术前无P V T患者行外科手术治疗,对比分析术后临床特征、血栓情况及再出血情况.结果术前两组患者一般临床资料匹配(P>0.05).与无PVT患者相比,门静脉高压合并PVT上消化道出血患者术后凝血功能、血小板、白细胞、出血量、手术时间、住院时间、肝脏功能、腹水、肝性脑病、血栓分布情况差异无统计学意义(P>0.05).与无PVT患者相比,存在PVT患者,术后血栓程度较重(?2=6.45,P<0.05).门静脉高压合并P V T上消化道出血患者,术后1、3、5年的累积出血率分别为0.00%、21.43%、21.43%,而对照组1、3、5年累积出血率0.00%、6.25%、6.25%,两者差异无统计学意义(?2=0.32,P>0.05).术前存在血栓组患者中,5例探查后改行冠腔分流、断流加分流术.结论脾切除+贲门周围血管离断术对门静脉高压合并PVT上消化道出血患者的治疗效果确切,但部分患者可根据个体情况施行冠腔分流术、断流加分流术.
AIM To evaluate the curative effect of surgical therapy of upper gastrointestinal bleeding in patients with portal hypertension and portal vein thrombosis （PVT）. METHODS Fourteen portal hypertensive patients with PVT and 32 portal hypertensive patients without PVT before operation who underwent surgical treatment for upper gastrointestinal bleeding were included in this study. The clinical features, blood clot formation, and rebleeding after surgery were compared between the two groups. RESULTS Before surgery, clinical data were comparable in the two groups （P 〉 0.05）. Compared with patients without PVT, patients with PVT had comparable blood coagulation, platelet count, white blood cell count, intraoperative blood loss, days of hospitalization, liver function, ascites, hepatic encephalopathy and thrombosis （P 〉 0.05）, but had more serious PVT after surgery （χ^2= 6.45, P 〈 0.05）. After surgery, the rates of rebleeding at 1, 3 and 5 years were 0%, 21.43% and 21.43% for patients with PVT, and 0%, 6.25%, and 6.25% for patients without PVT, and there were no significant differences between the two groups （P 〉0.05）. Conversion to coronary vein-inferior vena cava shunt alone or plus devascularization was needed in five patients with PVT. CONCLUSION Splenectomy with pericardial devascularization has a good effect in patients with portal hypertension, upper gastrointestinal hemorrhage and PVT, although some cases need conversion to other procedures such as coronary vein-inferior vena cava shunt alone or plus devascularization.
出处
《世界华人消化杂志》
CAS
2016年第35期4725-4732,共8页
World Chinese Journal of Digestology
基金
河南省高等学校重点科研基金资助项目
No.16A320078
河南省基础与前沿技术研究基金资助项目
No.162300410115~~
关键词
门静脉高压症
门静脉血栓
上消化道出血
脾切除+贲门周围血管离断术
Portal hypertension
Portal vein thrombosis
Upper gastrointestinal bleeding
Splenectomy with pericardial devascularization
