脾切除术后门静脉系血栓形成的临床诊治
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唐继红 E-mail:tangjhong@hotmail.com

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The diagnosis and treatment of portal vein thrombosis after splenectomy
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    摘要:

    目的:探讨脾切除术后门静脉血栓(portal vein thrombosis,PVT)和肠系膜静脉血栓 (mesenteric venous thrombosis,MVT) 形成的成因及诊治策略。
    方法:回顾分析2000年以来收治脾切除术后门静脉及肠系膜静脉血栓形成12例患者的临床资料。
    结果:全组病例脾切除后静脉系血栓的发生率为4.3%(12/280),其中PVT发生率为3.2 %(9/280),MVT发生率为1.1%(3/280)。PVT和MVT患者均出现白细胞增多,血小板计数升高,D-D二聚体检测阳性和凝血功能异常。彩色多普勒超声、增强CT检查及MRA门静脉成像确诊9例,同时行肠系膜上动脉血管造影确诊1例,因急性肠梗阻剖腹探查术确诊2例。9例经积极的全身抗凝、祛聚、溶栓治疗1~2周好转出院。2例MVT因肠坏死行小肠切除肠吻合术,术后全身抗凝、祛聚治疗,痊愈出院。1例PVT血栓急性发展至肝内门静脉,死于肝功能衰竭。
    结论:脾切除后门静脉系统血栓形成与多种因素有关。早期诊断与及时抗凝治疗对预后有重要影响。非手术治疗效果不佳应及时手术治疗。

    Abstract:

    Objective:To study the etiological factors and the treatment methods of portal vein thrombosis (PVT) and mesenteric venous thrombosis (MVT) after splenectomy.
    Methods:Clinical materials of 12 patients with PVT and MVT after splenectomy  were analyzed retrospectively.
    Results:Venous thrombosis occurred in 12 of 280 post-splenectomy patients (4.3%) including nine patients with PVT(4.3%)and three patients  with MVT(1.1%). All of the PVT patients had leukocytosis, increase  platelet count,  positive  D-dimer and abnormal  thromboplastic function. PVT and MVT were discovered with color ultrasonography, CT, and MRI in nine patients, with superior mesenteric artery angiography in one case, and at exploratory laparotomy because of acute intestinal obstruction in two cases. Nine patients were cured by anti-coagulation and thrombolytic therapy. Two MVT cases had small intestinal necrosis underwent intestioal resection and anastomosis, postoperative systemic anticoagulation and thrombolytic therapy, and were cured. One case of acute PVT thrombosis with progression to intrahepatic portal vein, died of liver failure.
    Conclusions:Post-splenectomy portal system thrombosis is related with many factors. Early diagnosis and prompt anticoagulant therapy has an important impact on prognosis. If results of non-operative therapy are not satisfactory, prompt surgical therapy is advocated.

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李铁汉|唐波|唐继红|付必莽|马峻峰|朱洪|张捷.脾切除术后门静脉系血栓形成的临床诊治[J].中国普通外科杂志,2010,19(12):1324-1326.
DOI:10.7659/j. issn.1005-6947.2010.12.019

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  • 收稿日期:2010-01-09
  • 最后修改日期:2010-11-04
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  • 在线发布日期: 2010-12-15