肝切除术后门静脉血栓形成16例诊治分析

目的 总结16例肝切除术后门静脉血栓(PH-PVT)形成的诊治方法及预后情况.方法 回顾性分析2015年2月至2021年2月北京清华长庚医院收治的16例PH-PVT患者的临床资料,总结其临床特征及诊疗经过.16例均经增强CT检查确诊.其中男7例,女9例,年龄34～74(58.44±11.29)岁.肝细胞癌(HCC)4例...

Analysis of diagnosis and treatment of post-hepatectomy portal vein thrombosis in 16 cases

Objective To summarize the diagnosis and treatment mothods and prognosis of post-hepatectomy portal vein thrombosis(PH-PVT)in 16 cases.Methods The clinical data of 16 patients with PH-PVT admitted to Beijing Tsinghua Changgung Hospital from February 2015 to February 2021 were retrospectively analyzed,and their clinical characteristics and diagnosis and treatment process were summarized.All the 16 cases were confirmed by enhanced CT examination.Among the 16 cases,there were 7 males and 9 females,aged 34-74(58.44±11.29)years old,including 4 cases of hepatocellular carcinoma(HCC),8 cases of perihilar cholangiocarcinoma(PHCC),1 case of cholangiocarcinoma,1 case of gallbladder cancer(GBca)invading the liver,1 case of intrahepatic bile duct papilloma and 1 case of intrahepatic bile duct stones.Results Among the 16 cases,except for 2 patients who were diagnosed with chronic PH-PVT on day 144 and day 351 after hepatectomy,the other 14 patients had the time of diagnosis of PH-PVT from day 1 to day 24 after the operation,with an average of 9th day.After the formation of PVT,4 patients had no clinical symptoms;9 patients had unexplained fever;4 patients had abdominal pain and nausea;3 patients had abdominal distension,hematemesis,blood in the stool and jaundice symptoms,and 5 patients eventually developed hepatic encephalopathy and liver failure.After anticoagulant,thrombolytic and surgical treatments,8 cases were improved and discharged,and 8 cases died.Conclusion There are many risk factors for PH-PVT.PH-PVT can be diagnosed by enhanced CT,and its treatment methods include anticoagulation,thrombolysis and surgical thrombus removal.At present,there is no clear method to predict and prevent PH-PVT,and early detection and early treatment are the keys to improving the prognosis of the patients.