断流术中门静脉置管在术后门静脉压力测定及血栓防治中的应用  

Portal pressure measurement,prevention and treatment of portal vein thrombosis via portal veinous catheterization after devascularization

作　　者：狄华明 田明国 杨勇 杜鹏 李智勇 丁洋 詹晶 邵一民 

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏人民医院肝胆外科,宁夏银川750002

出　　处：《宁夏医学杂志》2016年第11期997-999,共3页Ningxia Medical Journal

基　　金：宁夏对外科技合作项目(201420)

摘　　要：目的探讨脾切除联合贲门周围血管离断术中门静脉留置导管用于术后门静脉压力测定及门静脉血栓防治的临床效果及意义。方法连续对30例门静脉高压症患者实施脾切除联合贲门周围血管离断术,术中经门静脉置管,术后住院期间每日经留置导管测定门静脉自由压力、滴注肝素盐水或溶栓剂防治血栓形成,术后2个月拔除导管。结果 30例患者均行门静脉置管,脾切除前、脾切除后、贲门周围血管离断后、术后早期禁食期间门静脉自由压力分别为(3.29±0.46)k Pa、(2.32±0.45)k Pa、(2.51±0.43)k Pa和(2.80±0.43)k Pa,贲门周围血管离断后门静脉自由压力高于脾切除后门静脉自由压力,差异有统计学意义(P<0.05);术后早期禁食期间门静脉自由压力高于贲门周围血管离断后门静脉自由压力,差异有统计学意义(P<0.05)。术后早期发现新形成门静脉血栓2例(6.7%),经导管滴注尿激酶后溶栓成功。除1例导管过早脱落出血需再次手术止血外,无其他导管相关并发症发生。结论脾切除联合贲门周围血管离断术后经由门静脉留置导管滴注抗凝或溶栓制剂可有效防治门静脉血栓,经导管测定门静脉压力可准确地判断患者门静脉血流动力学的变化。Objective To explore the clinical effect and significance of portal pressure measurement, prevention and treatment of portal vein thrombosis via portal veinous catheterization after splenectomy and pericardial devascularization. Methods Portal veinous catheterization had been done consecutively in 30 patients with portal hypertension following splenectomy and pericardial devasculariza- tion. Postoperative portal pressure was measured and heparin saline was infused daily through the catheter. Thrombolytics was infused once portal venous thrombosis was diagnosed. The catheters were removed two months after operation. Results Intraoperative catheteriza- tion was successful in all 30 cases. The mean portal pressure of pre - splenectomy, post - splenectomy, post - devascularization and early postoperative period were respectively （ 3.29 ± 0.46） kPa, （ 2.32± 0.45 ） kPa, （2.51 ± 0.43 ） kPa and （ 2.80 ± 0.43 ） kPa. The pressure of post - devascularization was significantly higher than that of post - splenectomy （P 〈 0.05 ） and the pressure of early post - operative period was significantly higher than that of post - devascularization （P 〈 0.05 ）. Portal veinous thrombosis occurred in two cases in the early postoperative period, and successfully thrombolysed by urokinase infusion through the catheter. There were no other catheter related complications,except for one case with premature catheter removal that caused bleeding and required reoperation for hemostasis. Conclusions After splenectomy and pericardial devascularization, measurement of the portal pressure via the portal venous catheteriza- tion could accurately evaluate the hemodynamic changes of patients. Infusion of anticoagulant or thrombolytic agents can effectively pre- vent and cure portal vein thrombosis.

关 键 词：脾切除术 贲门周围血管离断术 门静脉置管 门静脉自由压力 门静脉血栓防治 

分 类 号：R657.34[医药卫生—外科学]