门静脉插管防治脾切除断流术后门静脉血栓形成

Prevention and Treatment for Portal Vein Thrombosis after Splenectomy and Devasculation with Portal Vein Catheterization

目的探讨门静脉插管防治脾切除断流术后门静脉血栓形成的安全性和有效性。方法自2004年4月至2005年5月,北京佑安医院肝胆外科共行脾切除断流术60例,其中35例留置门静脉插管,术后根据情况予以抗凝、溶栓等治疗。观察比较了该组患者手术前后血小板的变化、门静脉血流动力学变化、感染发生率、门静脉血栓的发生率和溶栓效果。结果脾切除断流术后患者血小板进行性升高,术后2周左右达到峰值,术后1月降至正常水平;术后门静脉最大流速、平均流速均明显减慢;门静脉插管感染1例;5例患者术前存在门静脉血栓,发生率为14.28%;术后7例患者出现门静脉血栓,发生率为20%;经门静脉插管予以溶栓抗凝治疗后,出院时复查门静脉血栓为6例,新发血栓者溶栓成功率为85.72%。结论经门静脉插管溶栓抗凝可有效防治脾切除断流术后门静脉血栓形成,为患者今后可能施行的肝移植手术保留条件。

Objective To investigate the safety and efficiency of portal vein catheterization for prevention and treatment of portal vein thrombosis after splenectomy and devasculation. Methods From April 2004 to May 2005, 35 cases of post-operative patient undergoing performed splenectomy and devasculation, catheters were placed and retained in portal veins through right gastroepiploic veins. Anticoagulation and thrombolysis treatment were given after operations. The changes of platalet, hemodynamics of portal vein, incidence of infection and thrombosis, outcome of thrombolysis were analysed. Results Platelet level rised after operation, reached peak about two weeks later, and lowered to normal about 1 month later. The maximum and mean velocity of portal vein blood flow became slower. There was 1 case who suffered from sepsis through portal vein catheter. 5 cases（ 14.28% ） suffered of portal vein thrombosis before operations. 7 cases developed portal vein thrombosis after operations. 6 cases （85.72%） of portal vein thromboses were given thrombolysis through portal vein catheters. Conclusion Portal vein thrombosis can be prevented and treated efficiently with anticoagulation and thrombolysis through portal vein catheter, which give these patients opportunities for liver transplantation later.