脾切除术后门静脉血栓形成11例临床分析  

Analysis of clinical data in 11 cases of portal vein thrombosis after splenectomy

作　　者：黄庆先[1] 王国斌[1] 孙念峰[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院普外科,武汉430022

出　　处：《腹部外科》2004年第1期34-35,共2页Journal of Abdominal Surgery

摘　　要：目的　探讨脾切除术后门静脉系统血栓 (Portalveinthrombosis,PVT)成因及诊断和治疗策略。方法　回顾 1 992年 1月～ 2 0 0 2年 1月 ,1 1例脾切除术后门静脉系统血栓形成患者的临床资料并对其进行分析、总结。结果　 4 98例患者脾切除术后有 1 1例 (2 .2 % )发生PVT。平均诊断时间 6 .1± 3.5d ,4 5 .5 %发生于骨髓增生性疾病 (Myeloproliferativedisorder ,MP)伴有巨脾患者 ,所有患者均出现白细胞增多和血小板计数升高。彩色多普勒超声及增强CT检查可以诊断。 1例死于败血症 ,余 1 0例经抗凝治疗血栓全部或部分溶解 ,随访 2 1个月无复发。结论　PVT多见于巨脾行脾切除术后 ,早期诊断。Objective To investigate the etiopathogenesis of portal vein thrombosis (PVT) after splenectomy as well as the strategy for diagnosis and treatment.Methods Clinical data of 498 patients with PVT following splenetomy from January 1992 to January 2002 were retrospectively analyzed. Among the 498 patients subject to splenectomy, 11 cases were suffered from PVT ( 2.2% ). The average time from onset of symptoms to diagnosis of PVT was 6.1 ± 3.5 days. The patients with myeloproliferative disorder associated with splenomegaly had a high incidence of PVT ( 45.5 %). All patients exhibited leukocytosis and elevated platelet counts.The diagnosis of PVT was established by Doppler ultrasound or by contrast enhanced CT scanning in all cases.Ten patients had complete or part resolution of the clot after anticoagulation and none of them had recurrence during a follow up of 21 months, except one patient died of sepsis. The others survived with no recurrence.Conclusion Most of PVT patients result from postsplenectomies in the patients with splenomegaly. Early diagnosis and prompt anticoagulation are key to a successful outcome.

关 键 词：脾切除术 术后并发症 门静脉血栓形成 原因 抗凝治疗 门脉高压症 

分 类 号：R657.6[医药卫生—外科学] R657.34[医药卫生—临床医学]