门静脉高压症行腹腔镜脾切除术后门静脉系统血栓形成预测因子的研究进展

Research progress of predictors for portal vein system thrombosis after laparoscopic splenectomy for portal hypertension

腹腔镜脾切术后门静脉系统血栓(PVST)形成具有高发生率、隐匿性与危害性。然而,腹腔镜脾切术后PVST的最佳的诊断方式、治疗方案以及预测因子在国内外尚未形成统一意见。目前认为脾切除术后PVST发生的机制可能与血液高凝状态及血流动力学改变有关,其形成的原因大致为全身系统疾病和引起血流动力学变化的因素。全身性疾病包括恶性肿瘤、血液性疾病、自身免疫性疾病等,引起血流动力学变化的因素包括手术方式及时长、血浆D-二聚体、血小板计数、脾脏体积、脾脏最长直径、术前脾静脉直径及门静脉直径等。笔者对门静脉高压症行腹腔镜脾切除术后PVST形成预测因子的相关研究结果做一综述,旨在方便广大临床工作者对腔镜脾切后PVST形成进行风险评估,从而更加精准地把握抗凝时机,减少此并发症引起的严重后果,同时加快患者术后康复。

The formation of portal vein system thrombosis (PVST) after laparoscopic splenectomy has a high incidence,concealment and harmfulness.However,the optimal diagnosis,treatment plan and predictive factors for PVST formation after laparoscopic splenectomy have not yet reached an agreement either at home or abroad.At present,the mechanism for PVST after splenectomy may be related to blood hypercoagulability and hemodynamic changes,and the major causes for its formation are the systemic system diseases and the factors contributing to the hemodynamic changes.Systemic diseases include malignant tumors,hematological diseases,autoimmune diseases,etc.The factors causing hemodynamic changes include surgical methods and operation duration,plasma D-dimer,platelet count,spleen volume and its maximum diameter,preoperative splenic vein diameter and portal vein diameter.Here,the authors summarize the research results related to the predictors for PVST formation after laparoscopic splenectomy for portal hypertension,so as to provide convenience for clinicians to predict the formation of PVST after laparoscopic splenectomy,thereby to more accurately capture the timing of anticoagulation and reduce severe consequences of this condition,and meanwhile accelerate the postoperative recovery of the patients.