CAJ | 학술논문

目的探讨门脉高压症脾亢患者脾切除+断流术后门静脉系统血栓形成(portal vein thrombogenesis,PVT)的原因及防治措施.方法总结河北省沧州市中心医院1994年8月至2013年5月178例脾切除+断流术患者的临床资料,其中102例术后早期应用低分子肝素钙抗凝为预防组,76例未用抗凝药为对照组.通过B超或强化CT检查,发现PVT 33例,分别采取尿激酶全身静脉溶栓、肝动脉插管溶栓、肠切除+ Fogarty导管静脉残端取栓等治疗.结果总血栓发生率为18.5％(33/178),抗凝组为8.8％(9/102),其中Ⅰ、Ⅱ级血栓7例,Ⅲ、Ⅳ血栓各1例,无肠坏死病例.对照组血栓发生率为31.6％(24/76),其中Ⅰ、Ⅱ级血栓7例,Ⅲ、Ⅳ级血栓17例,发生肠坏死5例,两组间血栓发生率对比差异有统计学意义(x2=14.932,P=0.000).预防组经溶栓治疗后血栓完全溶解7例,血栓分级降低2例.对照组经溶栓治疗后血栓完全溶解6例,血栓降级11例,采用经颈静脉肝内门腔静脉内支架分流术(TIPS)溶栓和取栓治愈1例,因消化道大出血死亡1例.发生肠坏死5例,其中死亡4例,1例因全部小肠和部分结肠坏死,仅做探查后关腹自动出院.结论脾切除断流术后PVT的形成是多种因素促成的结果,早期抗凝可明显降低其发生率,早发现、早治疗可避免由此引发的严重危害.
목적 탐토문맥고압증비항환자비절제+단류술후문정맥계통혈전형성(portal vein thrombogenesis,PVT)적원인급방치조시.방법 총결하북성창주시중심의원1994년8월지2013년5월178례비절제+단류술환자적림상자료,기중102례술후조기응용저분자간소개항응위예방조,76례미용항응약위대조조.통과B초혹강화CT검사,발현PVT 33례,분별채취뇨격매전신정맥용전、간동맥삽관용전、장절제+ Fogarty도관정맥잔단취전등치료.결과 총혈전발생솔위18.5％(33/178),항응조위8.8％(9/102),기중Ⅰ、Ⅱ급혈전7례,Ⅲ、Ⅳ혈전각1례,무장배사병례.대조조혈전발생솔위31.6％(24/76),기중Ⅰ、Ⅱ급혈전7례,Ⅲ、Ⅳ급혈전17례,발생장배사5례,량조간혈전발생솔대비차이유통계학의의(x2=14.932,P=0.000).예방조경용전치료후혈전완전용해7례,혈전분급강저2례.대조조경용전치료후혈전완전용해6례,혈전강급11례,채용경경정맥간내문강정맥내지가분류술(TIPS)용전화취전치유1례,인소화도대출혈사망1례.발생장배사5례,기중사망4례,1례인전부소장화부분결장배사,부주탐사후관복자동출원.결론 비절제단류술후PVT적형성시다충인소촉성적결과,조기항응가명현강저기발생솔,조발현、조치료가피면유차인발적엄중위해.
Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome.