门静脉高压症术后门静脉血栓的综合预防及体会

Comprehensive prevention and experience of portal vein thrombosis after operation of portal hypertension

目的探讨门静脉高压症术后门静脉血栓形成的有效预防措施。方法对100例门静脉高压症患者行脾切除联合贲门周围血管离断术或脾切除联合冠肾静脉分流术,术中经胃网膜右静脉置入导管测压,术后早期经导管滴注肝素盐水,出院后口服华法林使国际标准化比值(INR)维持在2.0~2.8,直至血小板恢复正常。结果86例接受断流术的患者中,门静脉血栓形成6例(7%),经导管滴注尿激酶溶栓治疗后血栓消失4例,2例随访24个月血栓无变化。14例脾切除联合冠肾静脉分流患者术后均无门静脉血栓形成。结论术后经胃网膜右静脉置管早期滴注肝素盐水,继而口服华法林可有效防止术后门静脉血栓形成。脾切除后脾静脉近侧结扎可降低门静脉血栓发生率。

Objective To investigate comprehensive measures preventing portal veinous thrombosis after operation of portal hypertension.Methods Pericardial devascularization with splenectomy or coronary renal shunt with splenectomy were performed on 100 patients with portal hypertension.During operation,a catheter was placed in the right gastroepiploic vein for measurement of the portal pressure.Early postoperative transcatheter infusion of heparin in saline was performed.Oral warfarin after discharge was used to maintain the international normalized ratio(INR)at 2.0 to 2.8 until platelet counts returned to normal.Results There were 86 patients underwent devascularization in the study and six patients(7%)developed portal veinous thrombosis.Early thrombolysis with urokinase was performed through the catheter.The thrombus disappeared in four cases and kept stable in another two cases for 24 months of following-up.Fourteen patients who underwent coronary renal shunt combined with splenectomy had no portal vein thrombosis.Conclusion Early postoperative intravenous infusion of heparin via the catheter of the portal vein,followed by oral administration of warfarin after discharge can effectively prevent postoperative portal vein thrombosis.Ligation of the proximal side of the splenic vein after splenectomy can reduce the incidence of portal vein thrombosis.