贲门周围血管离断术后门静脉系统血栓形成与预防

Portal vein thrombosis after devascularization operation and its prevention

目的探讨乙肝肝硬化门静脉高压症患者行贲门周围血管离断术后门静脉系统血栓形成（portal vein thrombosis，PVT）的原因及诊治。方法回顾性分析从2008年1月至2011年12月56例接受贲门周围血管离断术治疗的门静脉高压症患者的临床资料。按是否采用预防性抗凝治疗将患者分为两组，每组28例。运用Logit分析PVT形成的因素。结果本组有9例患者发生PVT，发生率为16％，其中预防性抗凝组PVT发生率为11％，未预防性抗凝组发生率为21％。Logit回归分析：患者年龄、性别、术前血小板值和术中是否结扎脾动脉均与患者并发PVT无明显关系；而术后血小板峰值（≥300×10^9／L）和门静脉血流方向与患者是否并发PVT有明显关系。未预防性抗凝组PVTⅠ、Ⅱ、Ⅲ和Ⅳ级分别为2、3、1和0例，而预防性抗凝组PVTⅠ、Ⅱ、Ⅲ和Ⅳ级分别为1、2、0和0例。溶栓治疗PVT有效，经抗凝治疗后9例均顺利出院，无1例死于该并发症。结论门静脉高压症贲门周围血管离断术后并发PVT患者中门静脉离肝性血流是决定性因素，血小板峰值≥300×10^9／L是重要的危险因素；其诊治关键在于早期发现和及时抗凝溶栓治疗，预防性抗凝可以明显降低PVT的发生率。

Objective To explore the pathogenesis, diagnosis, therapy and prevention of portal vein thrombosis （PVT） after devaseularization. Methods Data of 56 patients who underwent devaseularization because of cirrhotic portal hypertension between Jan. 2008 and Dec. 2011 were retrospectively analyzed. Patients were divided into two groups according to whether or not to receive prophylactic anticoagulant therapy. There were 28 eases in each group. The causes of PVT was analyzed by Logit regression. Results Among all patients, 9 patients developed PVT after operation （ 16% ）. The occurrence of PVT was 11% in preventive anticoagulant treatment group, and that was 21% in non- preventive anticoagulant treatment group. Logit regression showed that there was no relationship in PVT with sex, age, preoperative platelet count and intraoperative ligation of splenic artery beforehand. There were apparent correlation in PVT with centrifugal-flow of portal vein and peak value of platelet count over ≥300×10^9/L. All patients discharged uneventfully after anticoagulant treatment. Conclusions The definite cause of PVT after devaseularization is centrifugal-flow of portal vein and the peak value of platelet count over≥300×10^9/L is a pivotal risk factor. The key point of therapy is early diagnosis and early anticoagulant treatment.