【摘要】 目的探讨肝硬化门静脉高压症术后门静脉系统血栓形成(portal vein thrombosis, PVT)的临床诊断、治疗和预防。方法回顾性分析近5年来118例肝硬化门静脉高压症患者断流手术后3-5 d发现的35例PVT的临床资料。结果本组PVT的发生率为29．7％。35例PVT中出现发热17例,腹泻11例,腹胀9例,呕吐咖啡样液体及黑便4例,腹痛3例,腹水2例,上消化道大出血2例,13例无临床症状。均给予低分子右旋糖酐500 ml+丹参20 ml静注,每天1次;低分子肝素钙2500 IU皮下注射每8小时或每12小时1次,共10-14 d,尿激酶20～40万单位静脉滴注每天1次,共5-7 d,出院前改华发令口服。彩色超声结合螺旋CT或磁共振血管造影检查:门静脉完全再通12例,部分再通21例,无改善2例,大出血2例,死亡1例。结论及早行彩色超声检查有助于早期诊断PVT;及早进行抗凝祛聚、溶栓治疗效果确切,有助于防止肠管坏死的发生,预防再出血,降低病死率。更多还原

【Abstract】 Objective To evaluate the diagnosis and treatment of portal vein thrombosis (PVT) developed postoperatively in portal hypertensive patients undergoing portaazygous devascularization. Methods Clinical data of the 35 PVT cases identified 3-5 days postop out of 118 patients undergoing the surgery during recent 5 years were retrospectively reviewed. Result The overall incidence of PVT was 29.7%. Seventeen patients had a fever, 11 had a diarrhea, 9 cases had abdominal distention. Four experienced coffee-ground vomit and black stool. Three complained abdominal pain. Two each suffered from ascites and upper gastrointestinal massive hemorrhage. Thirteen cases were asymptomatic. All patients were treated with intravenous dextran- 40 500 ml and 20 ml Salvia miltiorrhiza, once a day for a week, low molecule heparin calcium 2500 IU subcutaneously every other 8 or 12 hours for 10 - 14 days, urokinase 200 000 - 400 000 IU iv drip daily for 5 - 7 days, and oral warfarin for 3 - 6 mouths after discharge. Clinical symptoms dramatically improved. Followed by color Doppler ultrasonography, spiral CT or MRI, portal vein completely recanalized in 12 cases, partly recanalized in 21 cases, remained unchanged in 2 cases. Two cases experienced massive hemorrhage and one died. Conclusion Color Doppler ultrasonography is most helpful to identify postoperative PVT. Therapy aimed at anticoagulation and thrombolysis when adopted early enough is most effective.更多还原