断流术后门静脉系统血栓形成及其防治

Thrombogenesis and its treatment in portal system after devascularization

目的探讨肝硬化门静脉高压症断流术后门静脉系统血栓的发生情况及其防治。方法回顾性分析113例肝硬化门静脉高压症断流术后患者的临床资料,患者肝硬化均由晚期血吸虫病和乙肝导致,分析其术后门静脉系统血栓形成的时间、部位,并探讨预防和治疗方法。结果 113例患者中,33例断流术后门静脉系统血栓形成,血栓形成发生率为29.2%。血栓形成时间为术后2~15 d,中位时间为术后6 d;单纯脾静脉和门静脉血栓各19例和10例,另4例脾静脉和门静脉均有血栓形成。经溶栓治疗后,30例血栓消失。结论多数患者断流术后门静脉系统血栓形成位于脾静脉。术中避免钳夹脾静脉主干、术后早期采取全身抗凝治疗能有效预防血栓形成。

Objective To discuss the occurrence of thrombosis in portal system of patients with cirrhotic portal hypertension after devascularization and the methods for treatment and prevention. Methods The clinical data of 113 patients with cirrhotic portal hypertension after the devascularization were collected and analyzed retrospectively, and the occurrence time, parts as well as the treatment and prevention methods were discussed. Results Among the 113 patients, 33 of them were found with thrombosis in their portal system, and the occurrence rate was 29.2%. The occurrence time of thrombosis was 2-15 days post-de- vascularization, and the median time was 6 days post-operation. Among the 33 cases with thrombosis, there were 19 cases of splenic vein thrombosis, 10 cases of portal thrombosis, and 4 cases of both of them. After the thrombolytic therapy, the thrombo- sises in 30 cases disappeared. Conclusions Most of the thrombosises in portal system happen in splenic vein post-devascular- ization. Avoiding clamping the trunk of splenic vein in the operation and taking thrombolytic therapy at the early stage after the operation can effectively prevent the occurrence of thrombosis.