原发性肝癌切除术后门静脉血栓相关性肝坏死的临床分析

目的 探讨原发性肝癌切除术后门静脉血栓相关性肝坏死的临床表现及诊疗方法 .方法 回顾性分析上海东方肝胆外科医院2018年11月至2019年10月8例原发性肝癌切除术后门静脉血栓相关性肝坏死患者的临床资料,包括患者的人口统计学特征、临床表现、手术方式、实验室检查及影像学检查结果 、临床诊疗及预后等.结果 原发性肝癌切除术...

Clinical analysis of liver necrosis associated with portal vein thrombosis after hepatectomy for primary liver cancer

Objective To investigate the clinical manifestations, diagnosis and treatment of liver necrosis associated with portal vein thrombosis after hepatectomy for primary liver cancer. Methods The clinical date of 8 patients with primary liver cancer who had postoperative liver necrosis associated with portal vein thrombosis after hepatectomy for primary liver cancer between Nov. 2018 and Oct. 2019 at Shanghai Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed, including demographic features, manifestations, surgical procedure, the results of the laboratory examination and imaging examination, clinical diagnosis, treatment and prognosis. Results Liver necrosis associated with portal vein thrombosis occurred within 2 weeks after operation, without specific clinical symptoms and signs. Laboratory examination mainly showed that patients’ALT and LDH had a sharp rise and coagulation function was impaired, which were the initial manifestation after surgery. Among the 8 cases, contrast-enhanced CT showed extensive necrosis in 6 cases, focal necrosis in 2 cases, and portal thrombosis in 5 cases. 5 cases with ultrasound examination showed no liver necrosis, and portal vein thrombosis found in 4 cases. Thrombus images were seen only in the main portal vein, and the left and right main branches of the portal vein. Among the 8 cases, 7 cases were treated mainly with anticoagulation and microcirculation promotion, etc. As a result, 5 cases survived and 2 cases died. One patient’s condition was mild, and was relieved after treatment with low molecular dextran and promoting microcirculation. ConclusionThe liver necrosis associated with portal vein thrombosis after hepatectomy for primary liver cancer is a rare and serious complication, characterized by rapid deterioration of liver function in the early course, extensive or focal hepatic necrosis with or without portal thrombosis showed in contrast-enhanced CT. Anticoagulation and microcirculation promotion have certain therapeutic effect. The precise mechanism, effective prevention and treatment require attention and further research.