原发性肝癌切除术后门静脉血栓形成的临床分析

The Clinical Analysis of Portal Vein Thrombosis After Liver Resection for Hepatocellular Carcinoma

目的:探讨原发性肝癌切除术后门静脉血栓形成的可能原因及防治方法。方法:回顾分析本中心2009年1月—2010年3月5例原发性肝癌切除术后门静脉血栓形成患者的临床资料,包括患者的人口统计学特征、手术方式、术后临床化验指标、相关的影像学检查结果、临床处理及预后。结果:原发性肝癌切除术后门静脉血栓形成的发生率为0.4%(5/1269),均发生在术后1周内,以谷丙转氨酶、谷草转氨酶和乳酸脱氢酶短时间内急剧升高为初发表现。除1例门静脉右支部分血栓形成予抗凝治疗后存活;其余4例门静脉主干血栓者经抗凝治疗及肠系膜上动脉置管间接溶栓治疗无效,均于血栓形成2周内死亡。结论:门静脉血栓形成是原发性肝癌切除术后一种少见的,但却是致命的血管并发症,其确切的发病机制、有效的预防及治疗方法需重视和进一步研究。

Objective：To identify the causes of portal vein thrombosis（PVT） after liver resection for hepatocellular carcinoma（HCC）,and to discuss the management of this complication.Methods： We reviewed the data of consecutive 5 cases of PVT after liver resection for HCC from January 2009 to March 2010.The data included demographic features,surgical procedure,postoperative laboratory values;and color ultrasonographic examinations or CT scan if necessary.Results： The incidence of PVT after liver resection for HCC was 0.4%（5/1269）.All PVT cases were diagnosed in 1 week after operation,and ALT,AST,and LDH increased rapidly.Hospital mortality related to PVT was 80%（4/5）.Low molecule-weight heparin as the anticoagulation therapy or indirect thrombolysis through superior mesenteric artery hardly saves the patients life,if the thrombosis involves the main trunk of portal vein.Conclusions： PVT is a rare but fatal vascular complication after liver resection for HCC.The precise mechanism,effective prevention and treatment need draw attention and further study.