部分脾栓塞术后门静脉系统血栓形成  

Portal vein thrombosis after partial splenic embolization

作　　者：蔡明岳[1] 孟晓春[1] 陈俊伟[1] 黄文薮[1] 周斌[1] 郭永建[1] 朱康顺[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,中山大学介入放射学研究所,广州510630

出　　处：《中华普通外科杂志》2011年第12期1002-1004,共3页Chinese Journal of General Surgery

基　　金：广东省科技计划项目（20108031600211）;广东省科技计划项目（2008A030201004）

摘　　要：目的 探讨部分脾栓塞术（partial splenic embolization,PSE）后门静脉血栓形成（portal vein thrombosis,PVT）的治疗方法和转归.方法 2006-2010年中山大学第三医院放射科对105例肝硬化患者（因脾功能亢进）行PSE治疗,其中60例在术后1～3个月行上腹部增强CT或MRI检查,发现PVT10例.10例中4例接受早期抗凝治疗,6例未行抗凝治疗.并对10例患者的临床转归情况做回顾性分析.结果 抗凝治疗患者中,血栓溶解或大部分溶解3例,血栓无明显变化伴少量腹水1例；未行抗凝治疗6例,血栓部分钙化1例,血栓范围增大5例.在PVT的5例患者中,2例在随访期间因食管胃底静脉曲张破裂出血接受经颈静脉肝内门-体分流术；2例发展为门静脉海绵样变、食管胃静脉曲张加重,伴有腹水；1例食管胃静脉曲张加重,随访期间出现黑便.结论 PVT是PSE术后严重并发症,早期发现并及时抗凝治疗可减少PVT引起的并发症.Objective To investigate the clinical outcome and treatment of portal vein thrombosis （PVT） following partial splenic embolization （PSE）.Methods From April 2006 to April 2010,105patients with hypersplenism caused by cirrhotic portal hypertension were treated with PSE.Contrastenhanced abdominal computed tomography or magnetic resonance imaging was performed routinely in 60patients before PSE and 1 -3 months after PSE.PVT was detected in 10 patients on images after the procedures.After PVT was diagnosed,4 patients received anticoagulant therapy immediately,and the other 6 patients did not receive therapy.Clinical data of these 10 PVT patients were analyzed retrospectively.Results 3 of 4 patients who received anticoagulant therapy had complete or partial resolution of the thrombus,and one developed mild ascites without thrombosis progression.Of the 6 patients who did not receive anticoagulant therapy,follow-up studies （6- 48 months,mean 16.9 months） demonstrated partial clot calcification in one,thrombosis progression in 5.Among those 5 patients with thrombosis progression,two experienced hematemesis due to variceal rupture and underwent transjugular intrahepatic portosystemic shunt,2 developed cavernous transformation,extensive collateral circulation,ascites and variceal progression,and one had variceal progression with melena during the follow-up period.Conclusions PVT is a severe complication of PSE.Early diagnosis and prompt anticoagulant therapy is effective in preventing PVT.

关 键 词：肝硬化 栓塞 治疗性 高血压 门静脉 血栓形成 

分 类 号：R575.2[医药卫生—消化系统]