脾切除加断流术后门静脉系统血栓的防治  

Prevention of portal venous system thrombosis after splenectomy and devasculation

作　　者：张秋学[1] 张执全[1] 刘汝海[1] 王铁功[1] 杨冬山[1] 张磊[1] 

机构地区：[1]河北省沧州市中心医院普外科,061001

出　　处：《中华肝胆外科杂志》2014年第4期277-279,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨门脉高压症脾亢患者脾切除＋断流术后门静脉系统血栓形成（portal vein thrombogenesis，PVT）的原因及防治措施。方法总结河北省沧州市中心医院1994年8月至2013年5月178例脾切除＋断流术患者的临床资料，其中102例术后早期应用低分子肝素钙抗凝为预防组，76例未用抗凝药为对照组。通过B超或强化CT检查，发现PVT33例，分别采取尿激酶全身静脉溶栓、肝动脉插管溶栓、肠切除＋Fogarty导管静脉残端取栓等治疗。结果总血栓发生率为18．5％（33／178），抗凝组为8．8％（9／102），其中I、Ⅱ级血栓7例，Ⅲ、Ⅳ血栓各1例，无肠坏死病例。对照组血栓发生率为31．6％（24／76），其中I、Ⅱ级血栓7例，Ⅲ、Ⅳ级血栓17例，发生肠坏死5例，两组间血栓发生率对比差异有统计学意义（x2=14．932，P=0．000）。预防组经溶栓治疗后血栓完全溶解7例，血栓分级降低2例。对照组经溶栓治疗后血栓完全溶解6例，血栓降级11例，采用经颈静脉肝内门腔静脉内支架分流术（TIPS）溶栓和取栓治愈1例，因消化道大出血死亡1例。发生肠坏死5例，其中死亡4例，1例因全部小肠和部分结肠坏死，仅做探查后关腹自动出院。结论脾切除断流术后PVT的形成是多种因素促成的结果，早期抗凝可明显降低其发生率，早发现、早治疗可避免由此引发的严重危害。Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone spleneetomy plus perieardial devascularization and post-operative portal vein thrombosis （portal vein thrombogenesis, PVT）. Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province, including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group, 76 cases without anticoagulant medicine as control group. 33 cases with PVT found by B ultrasound or CT scan, were treated with urokinase body intravenous thrombolysis, hepatic artery catheterization thrombolysis, intestinal resection of ＋ Fogarty catheter embolectomy vein stump treatment respectively. Results The total incidence of thrombosis was 18.5% （33/178） , prevention group was 8.8% （9/102） , including 7 cases in grade I , III, IV thrombus, in 1 cases, no intestine necrosis. The control group thrombosis rate was 31.6% （24/76）, including 7 cases in grade I , m, IV, thrombosis in 17 cases, 5 cases of intestine necrosis, two groups of thrombosis rate were significantly differences （X2 = 14. 932, P = 0. 000）. Thrombus disappeared completely in 7 cases, the thrombus grading decreased in 2 cases in the preventive group after thrombolysis, and thrombus disappeared completely in 6 cases, 11 cases of thrombosis degraded in the control group after treatment of thrombolysis, 1 case cured by TIPS with thrombolysis and thrombectomy, 1 case died of sudden digestive tract bleeding, Among 5 cases of intestinal necrosis, 4 cases died and 1 case undergone abdominal exploration being found with intestine ＆ colon necrosis. Conclusions There are a variety of factors causing PVT after splenectomy and devascularization. Early anticoagulation can significantly reduce the incidence of PVT, early discovery and treatment can prevent severe outcome.

关 键 词：高血压 门静脉 脾切除术 静脉血栓形成 肝素 

分 类 号：R657.6[医药卫生—外科学]