断流术后门静脉血栓的诊疗现状  

Diagnosis and treatment of portal vein thrombosis after splenectomy and gastroesophageal devascularization

作　　者：薛帅[1] 张强[1] 刘嘉[1] 王培松[1] 陈光[1] 

机构地区：[1]吉林大学第一医院普外科中心,吉林省长春市130000

出　　处：《世界华人消化杂志》2016年第29期4063-4069,共7页World Chinese Journal of Digestology

摘　　要：断流术是临床常用的治疗门脉高压上消化道出血的术式.其优点是止血确切且对肝功能影响较小,然而由于术后血液高凝状态以及血流动力学的变化,门静脉血栓(portal vein thrombosis,PVT)的发生率大大增加,引起严重并发症.超声、CT、核磁共振成像是临床常用的诊断PVT的方法 .确诊后可通过抗凝、介入、手术等方法给予有效控制及治疗.因为PVT多数出现在断流术围手术期,而且治疗效果局限,所以围手术期PVT的预防显得尤为重要.术前给予抗凝药物预防PVT形成,术中防止对门静脉系统血管内皮损伤,减少脾静脉盲端的形成,稳定术后门静脉的血流动力学.术后常规彩超复查,早期诊断,早期治疗.Splenectomy and gastroesophageal devascularization is the most common clinical treatment for upper gastrointestinal bleeding in patients with portal hypertension. Its advantages include exact treatment and little impact on liver function. However, due to the postoperative high blood coagulation state and hemodynamic changes, it greatly increases the incidence of portal vein thrombosis（PVT）, which causes serious complications.Ultrasound, CT and MRI are main methods for the diagnosis of PVT. After diagnosis, using anticoagulation, intervention and surgery can achieve effective control and treatment. PVT mostly occurs perioperatively and therapeutic effects are therefore limited, so perioperative PVT prevention is particularly important. It is recommended that anticoagulation drugs be given preoperatively to prevent PVT formation,injury to the vascular endothelium of the portal vein system be avoided intraoperatively to reduce the formation of spleen vein stump and stabilize postoperative portal vein blood flow dynamics, and ultrasound be performed postoperatively to achieve early diagnosis and treatment.

关 键 词：断流术 门静脉血栓 诊疗 

分 类 号：R657.34[医药卫生—外科学]