脾切除术后门静脉血栓形成的诊断及治疗策略

医学研究与教育 ›› 2014, Vol. 31 ›› Issue (6): 16-20.

脾切除术后门静脉血栓形成的诊断及治疗策略

张爱民，张涛，李日恒，杨季红，陈治

河北大学附属医院普外科，河北保定 071000

出版日期:2014-12-25 发布日期:2014-12-25
通讯作者: 张涛（1981—），男，河北保定人，主治医师，博士，主要从事消化道肿瘤的诊治，E-mail: zhtdou@163.com
作者简介:张爱民（1964—），男，河北乐亭人，主任医师，主要从事肝胆外科疑难病例及消化道肿瘤的微创治疗。

Discussion on diagnosis and treatment in portal vein thrombosis after splenectomy

ZHANG Aimin, ZHANG Tao, LI Riheng, YANG Jihong, CHEN Zhi

Department of General Surgery, Affiliated Hospital of Hebei University, Baoding 071000, China

Online:2014-12-25 Published:2014-12-25

摘要/Abstract

摘要： 目的探讨脾切除术后门静脉血栓（portal vein thrombosis，PVT）成因及诊断和治疗策略。方法回顾分析河北大学附属医院普外科 2010 年 1 月至 2013 年 1 月，16 例脾切除术后 PVT形成患者的临床及影像学资料并对其进行分析、总结。结果 135 例患者脾切除术后有 16 例（11.85%）发生 PVT，所有患者均经彩色多普勒超声及增强 CT 检查确诊。对比术前术后门静脉直径（1.53±0.19）cm vs （0.91±0.19）cm、脾静脉直径（1.36±0.27）cm vs （0.75±0.19）cm、门静脉血流速度（10.33±1.98）cm/s vs （13.56±2.31）cm/s，血栓组较非血栓组差异有统计学意义。结论术前门静脉直径及血流速度对于预测术后PVT形成有指导作用。PVT一经确诊，及时抗凝祛聚治疗，介入治疗也不失为一种较好的选择手段。

关键词: 门静脉血栓, 脾切除, 治疗

Abstract: Objective To investigate the clinical characteristics of PVT in order to find out effective approaches on its diagnosis and treatment. Methods The clinical data of 135 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2010 to January 2013 in our institution were collected. Clinical and surgical characteristics of the patients who developed PVT postoperatively and those who did not develop PVT were compared. Results 135 patients after splenectomy in 16 cases (11.85%) occurred in PVT, all patients were confirmed by color Doppler ultrasound or contrast-enhanced CT examination. The comparison of preoperative, postoperative width of portal vein(1.53±0.19) cm vs (0.91±0.19) cm, splenic vein diameter (1.36±0.27) cm vs (0.75±0.19) cm, portal vein blood flow velocity (10.33±1.98) cm/s vs (13.65±2.31) cm/s were thrombus group than in non portal thrombosis group had significant difference. In 15 cases with thrombus dissolving anticoagulant therapy in whole or in part, of which 5 cases underwent percutaneous portal vein puncture and catheterization thrombolysis, followed up for 1 years without recurrence. Conclusion Preoperative portal vein diameter and blood flow velocity in predicting postoperative portal vein thrombosis has the function of guidance. Once PVT is diagnosed, timely anticoagulation therapy, interventional therapy should be considered as a good choice.

Key words: portal vein thrombosis, splenectomy, treatment

中图分类号:

张爱民，张涛，李日恒，杨季红，陈治. 脾切除术后门静脉血栓形成的诊断及治疗策略[J]. 医学研究与教育, 2014, 31(6): 16-20.

ZHANG Aimin, ZHANG Tao, LI Riheng, YANG Jihong, CHEN Zhi. Discussion on diagnosis and treatment in portal vein thrombosis after splenectomy[J]. Medical Reserch and Education, 2014, 31(6): 16-20.

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