肝硬化脾切除术后门静脉系统血栓形成的原因分析

Analysis of the reasons of portal vein thrombosis after splenectomy for portal hypertension due to hepatic cirrhosis

目的探讨肝硬化门静脉高压患者行脾脏切除+贲门周围血管离断术后门静脉系统血栓(portalvein thrombosis,PVT)形成的原因。方法回顾性分析我院2004年1月至2010年1月204例肝炎后肝硬化门静脉高压症行手术治疗患者的临床资料。结果其中150例行脾切除+贲门周围血管离断术,54例行脾脏部分切除术+贲门周围血管离断术。术后发生PVT 30例,未发生PVT 174例;发生PVT患者的门静脉和脾静脉直径、术后门静脉血液流速及术后并发症与未发生PVT患者有显著性差异(P<0.0 5),脾脏部分切除术后患者PV T的发生率明显比脾脏切除患者低,有显著性差异(P<0.05)。结论门静脉和脾静脉直径、门静脉血液流速及术后并发症是肝硬化门脉高压症脾切+贲门周围血管离断术后PVT形成的危险因素,脾脏部分切除术可有效减少断流术后PVT的发生。

Objective To explore the contributory reasons leading to portal vein thrombosis（PVT） after splenectomy and pericardial devascularization for portal hypertension due to hepatic cirrhosis.Methods The clinical data of 204 patients with portal hypertension due to hepatic cirrhosis in our hospital from January 2004 to January 2010 were retrospectively analyzed.Results One hundred and fifty patients underwent splenectomy and pericardial devascularization,while 54 patients underwent partial splenectomy and pericardial devascularization.PVT occurred in 30 patients（14.7%）.There was significant difference in the diameter of portal veins and splenic veins,the blood flow of portal veins in two groups of patients with or without PVT（P 0.05）.The incidence of PVT in patients undergone splenectomy and pericardial devascularization or suffered from postoperative complications were much higher than that in the other group（P 0.05）.Conclusion The risk factors of PVT after splenectomy and pericardial devascularization for portal hypertension due to hepatic cirrhosis are： diameter of portal veins,diameter of splenic veins,blood flow of portal veins and complications.And partial splenectomy can decrease the incidence of PVT.