预防性切除术治疗肝外型门静脉瘤的临床价值  

Clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm

作　　者：陆树桐[1] 蒲淼水[1] 霍枫[1] 刘萧[1] 

机构地区：[1]广州军区广州总医院肝胆外科肝脏移植中心,510010

出　　处：《中华消化外科杂志》2017年第11期1149-1153,共5页Chinese Journal of Digestive Surgery

基　　金：广东省科技计划重点项目（2012A030400023）

摘　　要：目的探讨预防性切除术治疗肝外型门静脉瘤的临床价值。方法采用回顾性描述性研究方法。收集2014年5月广州军区广州总医院收治的1例肝外型门静脉瘤患者的临床资料。患者2013年底无明显诱因出现腹上区隐痛。2014年5月收治入院后行腹部B超、腹部CT、腹腔血管造影、肠系膜上动脉造影检查后诊断为肝外型门静脉瘤，结合患者个体情况，选择行预防性切除术治疗。手术方式选择肝外型门静脉瘤切除术，探查腹腔后，在术中超声检查的引导下，解剖并切除门静脉瘤，于文氏孔处放置双腔引流管1根，关腹。术后进行常规围术期管理。观察患者手术时间、术中出血量、术后饮食恢复时间、术后腹腔引流管拔除时间、术后并发症情况、实验室检查结果、影像学检查结果、切口愈合情况、术后出院时间、术后病理学检查结果、随访情况。患者术后通过门诊及电话方式进行随访．行腹部B超及CT检查了解门静脉情况及有无门静脉瘤复发。随访时间截至2014年12月。结果患者成功行完整肝外型门静脉瘤切除术，手术时间为85min，术中出血量约为150mL，术后3d逐步恢复正常饮食，生活完全自理，术后3d拔除腹腔引流管，未发生出血、门静脉血栓、肝功能异常等并发症，复查血常规、血生化等结果未见异常。术后复查B超见门静脉血流良好，腹腔cT血管造影检查示门静脉显影清楚，管腔无狭窄，血流通畅。手术切口愈合良好。患者术后9d出院。术后病理学检查结果为囊壁样组织，内衬单层扁平上皮细胞。壁由平滑肌构成，符合静脉结构。随访6个月，患者体质良好，无不适主诉，生活自理。随访期间未发现门静脉狭窄及血管瘤复发，未见其他并发症。患者术后无用药及其他特殊治疗。结论预防性切除术治疗肝外型门静脉瘤安全可行，疗效较好。Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm. Methods The method of retrospective descriptive study was conducted. The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected. The patient suffered from dull pain in his epigastrium, with no obvious causative factors. The patient recieved abdominal B-ultrasound, CT scans abdominal and superior mesenteric artery, angiographies after admission in May 2014, and was diagnosed as with extra-hepatic portal vein aneurysm. The preventative surgical resection was selected according to the patient＇s individual health status. Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration. A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed. Then the abdomen was closed. The patient received regular perioperative management. The operation time, volume of intraoperative blood loss, time for diet recovery, time of drainage tube removal, postoperative complications, results of laboratory tests, results of imaging findings, healing of incision, time of postoperative discharge from hospital, results of pathologic examination and follow-up were observed. Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014. Results The patient underwent successful extra-hepatic portal vein aneurysm resection. The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL. The patient gradually returned to normal diet and self-care ability at postoperative day 3, and the abdominal drainage tube was removed at postoperative day 3. No postoperati

关 键 词：门静脉瘤 肝外型 外科手术 预防性 肝外型门静脉瘤切除术 

分 类 号：R657.3[医药卫生—外科学]