经门静脉抗凝溶栓预防和治疗断流术后门静脉血栓形成

目的分析探讨门静脉高压症患者直接经门静脉抗凝预防和治疗门静脉血栓的安全性和有效性。方法收集97例门脉高压症患者的围手术期临床资料，观察经门静脉抗凝治疗对围手术期并发症和门静脉血栓形成的影响，并作相关统计学分析。结果97例肝硬化门脉高压症患者均顺利完成手术治疗，两组患者性别、年龄、入院时child-pugh评分、门静脉内径、血小板计数、凝血酶原时间、脾质量、切脾前和断流术后自由门静脉压、术中出血、术后7d门静脉血流速度和围手术期病死率均无统计学差异（均P〉0．05）。随访12周，治疗组4例、对照组14例门静脉血栓形成（P=0．048）。治疗组经门静脉溶栓后4／4再通，高于对照组1／5（P=O．007）。多元线性回归分析提示，入院时child-pugh评分、门静脉血流速度和是否经门静脉抗凝治疗与术后门静脉系统血栓形成有多元线性回归关系（P〈0．05）。结论门静脉血栓形成是多种因素共同作用的结果，经门静脉抗凝、溶栓预防和治疗断流术后门静脉血栓形成是安全和有效的。

Prevention and treatment of portal vein thrombosis by anticoagulant and thrombolytic tans-portal vein

Objective TO explore the safety and effectiveness of prevention and treatment of portal vein thrombosis by anticoagulant and thrombolytic trans-portal vein. Methods The perioperative clinical data of 97 patients with portal hypertension were collected, The influence of anticoagulant treatment trans-portal vein on portal vein thrombosis and perioperative complication was analyzed. Results Devascularization of 97 patients was successfully performed. The gender ,age ,chil-pugh score at admission, portal vein diameter, platelet count ,prothrombin time, mass of spleen, free portal pressure before splenectomy and after devascularization ,intraoperative hemorrhage, portal flow velocity postoperative 7 days and perioperative mortality were no significant difference（P〉 O.05）.The were 4 cases（9.76%）suffered portal vein thrombosis in treatment group and 14 cases（25.0%）in control group （P=0.048）12 weeks follow-up.4 cases were given thrombolysis and all recanalized in treatment group,5cases were given thrombolysis and only 1 case was recanalized in control group（P=O.OO7）.There were multiple linear regression relationships between child-pugh score ,portal vein blood flow velocity, anticoagulation therapy through portal vein catheters with portal vein thrombosis （P 〈 O.05）.Ccnclusion portal vein thrombosis was the result of many factors, prevention and treatment of portal vein thrombosis by anticoagulant and thrombolytic trans-portal vein after devascularization operation was safe and effective.