门静脉高压症外科手术后门静脉系统血栓形成的原因及防治

目的　探讨门静脉高压症外科手术后门静脉系统血栓形成的原因及处理。方法　回顾性分析我院 1992～ 2 0 0 1年施行肝炎后肝硬化门静脉高压症手术伴脾切除术 32 9例患者的临床资料 ,对其中 4 3例 (13 1% )术后出现门静脉系统血栓患者的临床资料进行统计和分析。结果　 4 3例门静脉系统血栓患者中 ,1例发生感染性门静脉炎死亡 ,其余均康复出院。单纯行脾切除或脾切除加断流术患者 138例 ,血栓形成 2 6例 (18 8% ) ;行脾切除加分流术患者 191例 ,血栓形成 17例 (8 9% ) ,差异有显著意义 (χ2 =8 4 4 ,P <0 0 1)。结论　门静脉高压症外科手术后门静脉系统血栓形成的主要原因是脾切除术后血小板升高 ,且与选择不同术式导致术后门静脉系统血流动力学改变有关。手术操作规范化、术后动态监测血小板总数、常规彩超检查及早期行抗凝祛聚疗法是防治门静脉高压症术后门静脉系统血栓形成的有效方法。

The reason and treatment of portal vein thrombosis in patients with portal hypertension postoperation

OBJECTIVE: To investigate reason and the management of portal vein thrombosis in patients with portal hypertension postoperatively. METHODS: 329 patients with portal hypertension in liver cirrhosis who had splenectomy was reviewed from 1992 to 2001.In whom 43 (13.1%) patients with portal vein thrombosis postoperative were analyzed. RESULTS: In these patients, except 1 died for portal vein phlebitis, all patients were recovered. There are 138 patients who underwent splenectomy or splenectomy and devascularization, 26 (18.8%) of them had thrombosis. 191 patients underwent splenectomy and portacaval or portasplenic shut, 17 (8.9%) of them had thrombosis. The data of these two groups have significant difference (chi(2) = 8.44, P < 0.01). CONCLUSIONS: Thrombocytosis postsplenectomy as well as the changes of portal hemodynamics is the main reason of portal vein thrombosis. Portal vein thrombosis is also in association with the operative ways. Operation standardization, dynamic examining platelet count, routine color ultrasonography examining and early anticoagulation therapy are the effective methods in preventing and managing portal thrombosis postoperation for portal hypertension.