选择性贲门周围血管离断术对门脉高压症术后门静脉血栓形成的临床研究  

Clinical study on the effects of selective pericardial devascularization for portal hypertension patients with postoperative portal viein thrombosis

作　　者：肖旭[1] 蔡卫华[1] 胡进勇[1] 王建新[1] 陈骏[1] 

机构地区：[1]南通市第三人民医院普外科,南通226006

出　　处：《肝胆外科杂志》2015年第2期135-137,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨选择性贲门周围血管离断术对门脉高压症术后门静脉血栓形成的影响。方法我院普外科2008年1月至2014年6月收治的105例肝硬化门脉高压症患者,分别采用选择性贲门周围血管离断术(观察组)54例和传统的贲门周围血管离断术(对照组)51例,比较两组术后门静脉血栓形成的发生率。结果观察组术后PVT发生率明显低于对照组,两组比较有统计学差异(P<0.05);脾脏切除前、后两组间门静脉自由静脉压(FPP)无显著性差异(P>0.05),两组断流后FPP均较断流前有所升高,对照组高于观察组;术后血小板计数和凝血功能检测,两组比较无显著性差异;术后观察组门静脉内径明显小于对照组,门脉血流速度观察组明显快于对照组。结论选择性贲门周围血管离断术可显著降低门脉高压症术后PVT发生率,合理保留了机体的自发性分流,可改善术后门静脉系统血流动力学,且手术简便易行,是外科治疗肝硬化门脉高压症的理想术式。Objective To investigate the effects of selective pericardial devascularization for portal hypertension patients with postoperative portal viein thrombosis（PVT）. Methods A total of 105 patients with portal hypertension admitted from Jan 2008 to Jun 2014 were divided into 2 groups. 54 patients were submitted to selective pericardial devascularization （observation group）, and 51 pa- tients were submitted to the non-selective pericardial devascularization （control group）. The rate of postoperative PVT were compared between the two groups. Results The rate of postoperative PVT in observation group was lower than that in control group（P 〈 0.05）. There was no significant difference of free portal pressure （FPP） between the two groups before and after splenectory （ P 〉 0. 05 ）, but the FPP was significantly lower in observation group than control group（P 〈 0.05 ）. The postoperative platelet count and the detecting of PT and AFTT between the two groups were no significant difference （ P 〉 0.05）. The postoperative portal vein diameter of the observa- tion group was significantly less than the control group, and the postoperative portal vein blood flow velocity was significantly faster than the control group. Conclusions The selective pericardial devascularization can effectively decrease the postoperative PVT rates in pa- tients with portal hypertension. It is a simple and convenient operation which reasonably preserves the patient ＇ s spontaneous shunts and improves the hemodynamics of portal vein system.

关 键 词：选择性贲门周围血管离断术 高血压 门静脉 血栓形成 

分 类 号：R575[医药卫生—消化系统]