脾切除联合贲门周围血管离断术后早期门静脉系统血栓分布及其发生率

Distribution and incidence of early portal venous system thrombosis after splenectomy combined with pericardial devascularization

目的探讨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症术后早期门静脉系统血栓(PVST)的分布及其发生率。方法回顾性分析2016年1月至2020年3月宁夏回族自治区人民医院96例肝硬化门静脉高压症行脾切除联合贲门周围血管离断术的患者临床资料,术后早期经胃网膜右静脉留置导管滴注肝素氯化钠溶液,观察术后2周内PVST发生情况。结果术后PVST发生率为100.0%,血栓分布为:残余脾静脉血栓96例(100.0%),门、肠系膜静脉血栓38例(39.6%)。在门、肠系膜静脉血栓中,门静脉主干血栓32例(33.3%),其中14例(14.6%)血栓面积<50%、14例(14.6%)血栓面积≥50%,4例(4.2%)为完全性血栓,主干血栓均与残余脾静脉血栓相连;肠系膜上静脉血栓6例(6.3%),其中4例合并门静脉主干血栓并与之相连,2例合并门静脉右支血栓并与脾静脉血栓相连;门静脉右支血栓18例(18.8%),门静脉左支血栓20例(20.8%);门、肠系膜静脉2处及以上血栓24例(25.0%)。结论肝硬化门静脉高压症脾切除联合贲门周围血管离断术后早期残余脾静脉内易形成血栓,残余脾静脉血栓向门静脉内蔓延可能是术后门、肠系膜静脉血栓的主要原因。

Objective To summarize the distribution and incidence of early portal venous system thrombosis (PVST) after splenectomy combined with pericardial devascularization.Methods The clinical data of 96 cases of portal hypertension who received splenectomy combined with pericardial devalcularization in Ningxia Hui Autonomous Region Hospital was retrospectively analyzed.Early postoperately,heparine saline was infused through the catheter placed in the right gastroepiploic vein during operation.The PVST occurrence was observed within 2 weeks after operation.Results PVST occurred in all of the 96 cases (100.0%).Distribution of the PVST was as follows:remnant splenic vein in 96 cases (100.0%),porto-mensenteric vein in 38 cases (39.6%) including main portal vein in 32 cases (33.3%).In main portal vein thrombosis,the rate of thrombus/portal vein cross-sectional area was <50% in 14 cases (14.6%),≥50% in 14 cases (14.6%) and complete thrombus in 4 cases (4.2%).All of the thrombus in themain portal vein was connected with those in remnant splenic vein.Thrombosis was found in superior mesenteric vein (SMV) in 6 cases (6.3%),in which,SMV thombosis was associated and connected with main portal vein thrombosis in 4 cases and SMV thrombosis was associated with portal vein branch thrombosis and connected with the remnant splenic vein thrombosis in 2 cases.Right portal vein thrombosis occurred in 18 cases (18.8%) and left portal vein thrombosis in 20 (20.8%).Thrombosis occurrence≥2 sites of the portomensenteric vein was in 24 cases (25.0%).Conclusions The remnant splenic vein tends to form thrombosis in the early time after splenectomy combined with pericardial devacularization for portal hypertension with liver cirrosis.Extension of the remnant splenic vein thrombosis would be the key factor of portomensenteric vein thrombosis.