脾切除术后门静脉血栓形成的研究进展

Research progress of portal vein thrombosis after splenectomy

目的总结脾切除术后门静脉血栓形成的发病机制、流行病学及风险因素,并总结脾切除术后门静脉血栓形成的临床预防、诊断及治疗的最新进展,以期为临床预防及治疗提供一定的参考。方法收集国内外脾切除术后门静脉血栓形成的相关文献并做一综述。结果脾切除术后门静脉血栓形成的发生率高,其发生为多因素综合作用的结果,但主要与脾切除术后脾静脉血流动力学改变相关。诊断方面以增强CT扫描作为首选,治疗方案目前并没有达成共识,主要以个体化治疗为主,预防性使用低分子量肝素抗凝可能降低门静脉血栓形成的风险。结论对脾切除术后门静脉血栓形成,我们应树立三级预防的观念,并需结合患者的病情采取个体化的治疗方案。

Objective To summarize the pathogenesis,epidemiology,and risk factors of portal vein thrombosis after splenectomy,and combined with the latest advances in clinical prevention,diagnosis,and treatment of portal vein throm bosis after splenectom y,so as to provide som e references for clinical prevention and treatment in the future.Method Literatures on portal vein thrombosis after splenectomy were collected and reviewed.Results The incidence of portal vein throm bosis after splenectomy was high and its occurrence was the result of multiple factors.It was mainly related to the change of splenic venous blood flow mechanics after splenectomy.In terms of diagnosis,enhanced CT scan was the first choice.Currently,there was no consensus on treatment options,which mainly focused on individualized treatment and emphasized that preventive anticoagulant use of low-m olecular-weight heparin may reduce the risk of portal vein thrombosis.C onclusion The concept of tertiary prevention of portal vein throm bosis after splenectom y should be established,and individualized treatment should be adopted in combination with the patient’s condition.