门静脉高压症外科手术后门静脉系统血栓形成

目的：探讨门静脉高压症外科手术后门静脉系统血栓形成率及原因.方法：回顾性分析我院近8年采用脾肾分流加门奇断流联合手术和门奇断流术治疗233例病人门静脉高压症的临床资料,并应用核磁共振血管造影测量门静脉、脾静脉和肠系膜上静脉流速.结果：断流手术后门静脉系统血栓形成率为91.06%,且均有脾静脉血栓形成,门静脉主干血栓形成占其中25.89%,联合手术后血栓形成率为10.91%.与术前相比,血栓组术后门静脉（PV）和脾静脉（SV）流速下降显著,无血栓组术后PV和SV的流速无显著下降.术后血栓组SV的流速与无血栓组病人比较有非常显著的降低.血栓组和无血栓组在术前和术后的相同时间,病人血小板无显著性差异,PT延长时间两组手术前后及两组间均无显著性差异.结论：门静脉高压症断流手术后门静脉系统血栓形成率高达91.06%,且均有脾静脉血栓形成.门静脉系统血液流速减缓在术后门静脉系统血栓形成中起重要作用.脾切除后病人血小板升高并非是形成血栓的主要原因.脾肾静脉分流联合断流术在减少门静脉系统血栓形成中有很大优势.

Portal vein thrombosis formation in patients submitted to portal hypertension operation

Objective To investigate the incidence and causes of postoperative portal vein thrombosis(PVT) in patients after shunting and(or) devascularization operations.Methods Two hundred and thirty-three cases of portal hypertension undergoing either proximal spleno-renal shunt combined with pericardial devascularization(PSRS plus PCDV) or PCDV alone were retrospectively analyzed.The blood flow velocity of portal venous system was determined by magnetic resonance angiography.Results The incidence of PVT in PCDV group was 91.06%.Among these cases,the incidence of thrombosis formed in the splenic vein and the portal vein trunk was 100% and 25.89%,respectively.The incidence of PVT in PSRS plus PCDV group was 10.91%.The blood flow velocity in the portal vein(PV) and the splenic vein(SV) was significantly decreased after thrombosis formation,and more significantly in the SV,as compared with those without thrombosis.However,no differences were found in blood platelet count and prothrombin time(PT) between these two groups.Conclusions Changes of portal hemodynamics play an important role in the PVT formation postoperatively and thrombocytosis is not the main reason.PSRS plus PCDV is a practical operation in decreasing the incidence of PVT.