原发性肝癌切除术后门静脉血栓形成的预防及治疗  

Prevention and Treatment of Portal Vein Thrombosis After Liver Resection for Hepatocellular Carcinoma

作　　者：廖方[1] 杨平华[2] 张宝华[2] 杨玨 杨新伟[2] 谭蔚锋[2] 

机构地区：[1]惠州市第一人民医院肝胆外科,惠州516001 [2]上海东方肝胆外科医院腹腔镜科,上海200438

出　　处：《肝胆外科杂志》2016年第2期126-129,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨原发性肝癌切除术后门静脉血栓形成的可能原因及防治方法。方法回顾分析我科自2013年1月～2014年10月8例原发性肝癌患者行肝部分切除术后门静脉血栓形成的临床资料，包括患者的一般资料、手术部位、术后临床化验指标、相关的影像学检查结果、临床处理及预后。结果原发性肝癌切除术后门静脉血栓形成的发生率为2．05％（8／389），均发生在术后10天内，临床表现以腹胀、腹部不适、腹水形成、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素和乳酸脱氢酶在短时间内急剧升高为初发表现。除3例门静脉血栓早期予抗凝、溶栓治疗后存活；其余5例门静脉主干血栓者经抗凝及溶栓治疗无效，均于血栓形成2周左右死亡。结论门静脉血栓形成是原发性肝癌切除术后一种少见的，但却是相当的严重的并发症，其确切的发病机制、有效的预防及治疗方法需重视和进一步研究。Objective To investigate the possible causes and prevention methods after resection of hepatocellular carcinoma portal vein thrombosis. Methods A retrospective my department since October 2013 - October 2014 eight cases of primary liver cancer patients after partial hepatectomy portal vein thrombosis clinical data, general information, including the patient, the surgical site, postoperative clinical laboratory indicators related The imaging findings, clinical treatment and prognosis. Results Primary liver cancer resection of portal vein thrombosis incidence of 2.05% （8/389）, occurred within 10 days after surgery, the clinical manifestations of bloating, abdominal discomfort, ascites, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin and lactate dehydrogenase sharp rise in short as the initial manifestation. In addition to three cases of portal vein thrombosis early to anticoagulation after thrombolysis survived ; the remaining five cases of portal vein thrombosis by anticoagulation and thrombolytic therapy, both in thrombosis died about two weeks. Conclusion The portal vein thrombosis is a rare primary liver resection, but it is a very se- rious complication, its exact pathogenesis, effective prevention and treatment methods require attention and further study.

关 键 词：门静脉血栓 肝细胞肝癌 肝切除 并发症 

分 类 号：R735.7[医药卫生—肿瘤]