CAJ | 학술논문

目的探讨部分脾栓塞术(partial splenic embolization,PSE)后门静脉血栓形成(portal vein thrombosis,PVT)的治疗方法和转归.方法 2006-2010年中山大学第三医院放射科对105例肝硬化患者(因脾功能亢进)行PSE治疗,其中60例在术后1～3个月行上腹部增强CT或MRI检查,发现PVT10例.10例中4例接受早期抗凝治疗,6例未行抗凝治疗.并对10例患者的临床转归情况做回顾性分析.结果抗凝治疗患者中,血栓溶解或大部分溶解3例,血栓无明显变化伴少量腹水1例；未行抗凝治疗6例,血栓部分钙化1例,血栓范围增大5例.在PVT的5例患者中,2例在随访期间因食管胃底静脉曲张破裂出血接受经颈静脉肝内门-体分流术；2例发展为门静脉海绵样变、食管胃静脉曲张加重,伴有腹水；1例食管胃静脉曲张加重,随访期间出现黑便.结论 PVT是PSE术后严重并发症,早期发现并及时抗凝治疗可减少PVT引起的并发症.
목적 탐토부분비전새술(partial splenic embolization,PSE)후문정맥혈전형성(portal vein thrombosis,PVT)적치료방법화전귀.방법 2006-2010년중산대학제삼의원방사과대105례간경화환자(인비공능항진)행PSE치료,기중60례재술후1～3개월행상복부증강CT혹MRI검사,발현PVT10례.10례중4례접수조기항응치료,6례미행항응치료.병대10례환자적림상전귀정황주회고성분석.결과 항응치료환자중,혈전용해혹대부분용해3례,혈전무명현변화반소량복수1례；미행항응치료6례,혈전부분개화1례,혈전범위증대5례.재PVT적5례환자중,2례재수방기간인식관위저정맥곡장파렬출혈접수경경정맥간내문-체분류술；2례발전위문정맥해면양변、식관위정맥곡장가중,반유복수；1례식관위정맥곡장가중,수방기간출현흑편.결론 PVT시PSE술후엄중병발증,조기발현병급시항응치료가감소PVT인기적병발증.
Objective To investigate the clinical outcome and treatment of portal vein thrombosis (PVT) following partial splenic embolization (PSE).Methods From April 2006 to April 2010,105patients with hypersplenism caused by cirrhotic portal hypertension were treated with PSE.Contrastenhanced abdominal computed tomography or magnetic resonance imaging was performed routinely in 60patients before PSE and 1 -3 months after PSE.PVT was detected in 10 patients on images after the procedures.After PVT was diagnosed,4 patients received anticoagulant therapy immediately,and the other 6 patients did not receive therapy.Clinical data of these 10 PVT patients were analyzed retrospectively.Results 3 of 4 patients who received anticoagulant therapy had complete or partial resolution of the thrombus,and one developed mild ascites without thrombosis progression.Of the 6 patients who did not receive anticoagulant therapy,follow-up studies (6- 48 months,mean 16.9 months) demonstrated partial clot calcification in one,thrombosis progression in 5.Among those 5 patients with thrombosis progression,two experienced hematemesis due to variceal rupture and underwent transjugular intrahepatic portosystemic shunt,2 developed cavernous transformation,extensive collateral circulation,ascites and variceal progression,and one had variceal progression with melena during the follow-up period.Conclusions PVT is a severe complication of PSE.Early diagnosis and prompt anticoagulant therapy is effective in preventing PVT.