摘要
目的 探讨脾切除联合贲门周围血管离断术中行脾静脉近端结扎、胃网膜右静脉置管联合术后经导管溶栓抗凝、序贯口服华法林治疗门静脉血栓的疗效。方法 回顾性分析2020年1月至2021年12月宁夏回族自治区人民医院肝胆外科21例术前并发门静脉血栓的肝硬化门静脉高压症病人资料。所有病人均行脾切除联合贲门周围血管离断术、经胃网膜右静脉置管以及脾静脉近端结扎;术后均经胃网膜右静脉导管滴注尿激酶溶栓及低分子肝素溶液抗凝;出院后口服华法林直至门静脉血栓消退,术后定期随访。结果 术后不同时段与术前结果比较,术后7 d门静脉血栓无变化8例(38.1%)、血栓减小13例(61.9%),术后3个月血栓减小14例(66.7%)、血栓消失7例(33.3%),术后6个月血栓消失18例(85.7%),门静脉海绵样变3例(14.3%)。全部病人食管胃静脉曲张较术前明显缩小,无复发及再出血发生。结论 脾切除联合贲门周围血管离断术中行脾静脉近端结扎及经胃网膜右静脉留置导管,术后早期经胃网膜右静脉导管溶栓抗凝,以及后期口服华法林是门静脉高压症并发门静脉血栓的有效治疗方法。
Objective To investigate the efficacy of proximal splenic vein ligation during splenectomy combined with pericardial devascularization and postoperative transcatheter thrombolysis and anticoagulation through right gastroepiploic vein and sequentially oral warfarin for portal vein thrombosis.Methods The data of 21 cases of portal hypertension complicated with portal vein thrombosis who were hospitalized in the Hepatobiliary Department of the People's Hospital of Ningxia Hui Autonomous Region from January 2020 to December 2021 and received surgical treatment were retrospectively analyzed.All the patients received splenectomy combined with pericardial devascularization,right gastroepiploic vein catheterization,and proximal splenic vein ligation.After surgery,urokinase and low molecular heparin solution were injected through the catheter for thrombolysis and anticoagulation.After discharge,warfarin was orally taken until the thrombus was resolved.Regular postoperative follow-up was carried out.Results By comparison with preoperative thrombus,thrombus did not change in 8 cases(38.1%) and reduced in 13(61.9%) at 7 days after surgery,thrombus reduced in 14 cases(66.7%) and disappeared in 7(33.3%) at 3 months after surgery,and thrombus disappeared in 18 cases(85.7%) and developed to cavernous transformation of portal vein in 3(14.3%) at 6 months after surgery.The preoperative esophagogastric varices were significantly reduced in all the patients and there was no recurrence of bleeding.Conclusion Combination of proximal splenic vein ligation and catheterization of the right gastroepiploic vein during pericardial devascularization,early transcatheter thrombolysis and anticoagulation,and late oral warfarin is an effective comprehensive treatment for portal hypertension complicated with portal vein thrombosis.
作者
李宝定
田明国
卜阳
丁妮
LI Bao-ding;TIAN Ming-guo;BO Yang(Department of Hepatobiliary Surgery,People’s Hospital of Ningxia Autonomous Region,Yinchuan 750002,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2023年第11期1279-1283,共5页
Chinese Journal of Practical Surgery
基金
宁夏回族自治区重点研发计划项目(No.2022BEG02038)。
关键词
门静脉高压症
门静脉血栓
脾切除联合贲门周围血管离断术
脾静脉近端结扎
经导管溶栓
portal hypertension
portal vein thrombosis
splenectomy and pericardial devascularization
proximal splenic vein ligation
transcatheter thrombolysis
