门静脉血栓54例临床特点并文献复习

Clinical Features of 54 Cases of Portal Vein Thrombosis（PVT） and Literature Review

目的．探讨门静脉血栓（poral vein thrombosis，PVT）的临床表现、可能原因、分型、诊断和治疗方法。方法对2014年1月-2017年10月，中国人民解放军总医院急诊抢救间收治的54例PVT的临床资料进行回顾性分析，并复习相关文献。结果急性血栓多以腹痛来诊，慢性血栓多以腹胀、消化道出血来诊。腹痛性质多为胀痛和绞痛。疼痛位置或疼痛最明显位置多为上腹、左腹和脐周。部分患者伴恶心、呕吐、腹胀、停止排气排便或排气排便减少等。引起PVT可能原因为某些易栓疾病、乙肝肝硬化、骨髓增生性肿瘤、过敏性疾病或多种物质过敏、近期生育史、脾亢、脾切除、嗜酸粒细胞升高、胰腺占位、胰腺炎等。实验室检查大多数患者白细胞升高超过正常范围，白细胞〉15者近112。几乎所有患者D-二聚体升高超过正常范围，部分患者D-二聚体〉20。半数患者肝酶升高超过正常范围，但均是轻度升高。部分患者血小板小于正常，部分患者血小板升高超过正常范围。血小板降低也可能与应用抗凝药物有关。结论随着临床医师对PVT的认识逐渐加深，以及影像学技术的发展，该病逐年增多，临床医生应加强对该病的认识和进一步研究有效的治疗方法以期减少误诊漏诊和为更多患者解除病痛。

Objective To investigate the clinical manifestations, possible causes, classification, diagnosis and treatment of portal vein thrombosis （PVT）. Methods a retrospective analysis of the clinical data of 54 cases of PVT in the emergency department of our hospital from 2014 to 2017 October was reviewed and the related literature was reviewed. Results most of the acute thrombus was diagnosed with abdominal pain, and the chronic thrombus was diagnosed mostly with abdominal disteution and gastrointestinal bleeding. The nature of abdominal pain is flatulence and colic. The most obvious location of the pain position or pain is the upper abdomen, the left abdomen and the umbilicus. Some patients were accompanied by nausea, vomiting, abdominal distention, discontinuation of exhaust defecation, or reduced exhaust defecation. Some possible reasons for causing PVT thrombophilia disease, liver cirrhosis, myeloprotiferative neoplasms, allergic disease or allergic substances, recent reproductive history, hypersplenism, splenectomy, eosinophils increased, pancreatic occupying and acute pancreatitis. Laboratory tests showed that most of the patients had more than n~~rmal leucocyte increase, and white blood cells accounted for almost balf ~fl the 15. In almost all patients, the D- two polymer was higher than the normal range, and the D7- two polymer was more than 20 in some patients. The increase of liver enzymes in half of the patients exceeded the normal range, but all of them were slightly elevated. In some patients, platelets were less than normal, and in some patients, the elevation of platelets exceeded the normal range. Thromboeytopenia may also be associated with the application of anticoagulants. Conclusion with the increasing understanding of PVT and the development of imaging technology, the disease is increasing year by year. Clinicians should strengthen the understanding of this disease and further study effective treatment methods, in order to reduce misdiagnosis and missed diagnosis and relieve pain for more patients.