脾切除术后门静脉血栓形成的诊断及治疗策略  

Discussion on diagnosis and treatment in portal vein thrombosis after splenectomy

作　　者：张爱民[1] 张涛[1] 李日恒[1] 杨季红[1] 陈治[1] 

机构地区：[1]河北大学附属医院普外科,河北保定071000

出　　处：《医学研究与教育》2014年第6期16-20,共5页Medical Research and Education

摘　　要：目的探讨脾切除术后门静脉血栓(portal vein thrombosis,PVT)成因及诊断和治疗策略。方法回顾分析河北大学附属医院普外科2010年1月至2013年1月,16例脾切除术后PVT形成患者的临床及影像学资料并对其进行分析、总结。结果 135例患者脾切除术后有16例(11.85%)发生PVT,所有患者均经彩色多普勒超声及增强CT检查确诊。对比术前术后门静脉直径(1.53±0.19)cm vs(0.91±0.19)cm、脾静脉直径(1.36±0.27)cm vs(0.75±0.19)cm、门静脉血流速度(10.33±1.98)cm/s vs(13.56±2.31)cm/s,血栓组较非血栓组差异有统计学意义。结论术前门静脉直径及血流速度对于预测术后PVT形成有指导作用。PVT一经确诊,及时抗凝祛聚治疗,介入治疗也不失为一种较好的选择手段。Objective To investigate the clinical characteristics of PVT in order to ifnd out effective approaches on its diagnosis and treatment.Methods The clinical data of 135 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2010 to January 2013 in our institution were collected. Clinical and surgical characteristics of the patients who developed PVT postoperatively and those who did not develop PVT were compared.Results 135 patients after splenectomy in 16 cases （11.85%） occurred in PVT, all patients were conifrmed by color Doppler ultrasound or contrast-enhanced CT examination. The comparison of preoperative, postoperative width of portal vein（1.53±0.19） cm vs （0.91±0.19） cm, splenic vein diameter （1.36±0.27） cm vs （0.75±0.19） cm, portal vein blood flow velocity （10.33±1.98） cm/s vs （13.65±2.31） cm/s were thrombus group than in non portal thrombosis group had signiifcant difference. In 15 cases with thrombus dissolving anticoagulant therapy in whole or in part, of which 5 cases underwent percutaneous portal vein puncture and catheterization thrombolysis, followed up for 1 years without recurrence.Conclusion Preoperative portal vein diameter and blood lfow velocity in predicting postoperative portal vein thrombosis has the function of guidance. Once PVT is diagnosed, timely anticoagulation therapy, interventional therapy should be considered as a good choice.

关 键 词：门静脉血栓 脾切除 治疗 

分 类 号：R65[医药卫生—外科学]