门静脉高压症门静脉血栓形成的机制研究

Risk factors of portal venous thrombosis development in patients with portal hypertension

目的:探讨肝硬化门静脉高压症病人术后门静脉系统血栓形成的原因。方法:回顾性分析2011年1月至12月间收治资料完整的40例肝硬化门静脉高压症病人术前术后的临床资料,分析术前术后门静脉系统血栓形成与凝血功能及血流动力学状况之间的关系。结果:术前在有无门静脉系统血栓形成的两组间各项凝血功能参数均无统计学差异,唯门静脉血流速度在血栓组较无血栓组显著减慢(P<0.05)。断流术后脾静脉均有血栓形成,其中9例向门静脉主干蔓延。脾肾静脉分流加断流的联合手术后,除1例门静脉主干血栓逆向蔓延至脾静脉外,肠系膜上静脉血至脾静脉经脾肾分流口分流入体循环,约2/3的病人在门静脉左右支或主干内有部分血栓。术后有无血栓形成的两组间血小板数量无统计学差异,D-二聚体均较正常值为高但两组间差异无统计学意义。结论:肝硬化门静脉高压症病人无论何种手术方式,术后门静脉系统均有血栓形成可能,血栓形成主要与门静脉系统血流动力学改变有关。

Objective To investigate the risk factors related with portal vein thrombosis （PVT） in patients with portal hypertension caused by liver cirrhosis. Methods From Jan to Dec 2011, 40 patients with portal hypertension and liver cirrhosis were analyzed of the risk factors of PVT. Results The velocity of portal vein was much lower in the pre- operative PVT group than that in non PVT group （P〈0.05）. No difference was observed in coagulation function between the patients with and without PVT. All patients with devascularization suffered splenic vein thrombosis, 9 of whom had thrombosis extended to the trunk of portal vein. In patients with both splenorenal shunt and devascularization, blood in superior mesenteric vein flowed into systemic circulation through splenorenal shunt except one patient with thrombosis in portal vein extended back to splenic vein. Two-thirds of these patients had partial thrombosis formed in portal trunk. There was no difference of platelet levels between the two groups. D-dimer higher than normal level, however did not differ between the two groups. Conclusions PVT may occur independent of operation approaches. It may correlate with the changes of portal hemodynamics.