肝癌术后门静脉血流障碍的处理  

The manegement of Portal Vein blood disorder After Liver Resection for Hepatocellular Carcinoma

作　　者：段纪成[1] 杨珏[1] 刘凯[1] 常颜信[1] 范明明[1] 冉荣征[1] 杨家和[1] 

机构地区：[1]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4期259-261,共3页Journal of Hepatobiliary Surgery

摘　　要：目的观察原发性肝癌切除术后门静脉血流障碍的可能原因及防治方法。方法回顾分析上海东方肝胆外科医院16例原发性肝癌切除术后门静脉血流障碍患者的临床资料,含手术方式、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发生门静脉血流障碍16例,其中门静脉血栓13例,血流变慢3例,均发生在术后3天,以谷丙转氨酶、谷草转氨酶和乳酸脱氢酶短时间内急剧升高为初发表现;3例血流变慢及6例门静脉分支部分血栓形成予抗凝治疗后存活;4例门静脉主干血栓未行抗凝治疗,3例门静脉主干血栓者经抗凝治疗无效,均于血栓形成1周内死亡。结论门静脉血流障碍是原发性肝癌切除术后一种少见并发症,死亡率高,其发病原因不明,目前缺乏有效的预防及治疗方法。Objective Observation of the cause of portal vein blood disorder after liver resection for hepatocellular carcinoma （HCC） , discussion of the management of this complication. Methods： 16 cases of portal vein blood flow disorder after liver resection for HCC were analysed retrospectively in Eastern Hepatobiliary Surgery Hospital. including clinical data, surgical procedure, postoper- ative clinical assay index, imaging findings, clinical treatment and prognosis. Results 16 cases were diagnosed from clinical assay in- dex, imaging findings, including 13 cases of portal vein thrombosis, 3 cases showed slower, occurred in 3 days postoperatively, glu- tamic-pyrnvic transaminase glutamic oxalacetic transaminase lactic dehydrogenase increased rapidly in a short period of time as the first manifestation; 3 cases showed slow and 6 cases with part branch of portal vein thrombosis to survive after anticoagulation; 4 cases of main portal vein thrombosis no anticoagulant treatment, 3 cases of portal vein thrombosis who received anticoagulant treatment also died in thrombosis within 1 week. Conclusion Portal vein blood flow barriers is a rare complication after liver resection for HCC, mortality is high, its etiology is unknown, also lack of effective prevention and treatment.

关 键 词：肝细胞肝癌 肝切除术 并发症 门静脉血流障碍 

分 类 号：R735.7[医药卫生—肿瘤]