| 摘要: |
| ［摘要］ 目的 总结16例肝切除术后门静脉血栓（PH-PVT）形成的诊治方法及预后情况。方法 回顾性分析2015年2月至2021年2月北京清华长庚医院收治的16例PH-PVT患者的临床资料，总结其临床特征及诊疗经过。16例均经增强CT检查确诊。其中男7例，女9例，年龄34～74（58.44±11.29）岁。肝细胞癌（HCC）4例，肝门部胆管癌（PHCC）8例，胆管癌1例，胆囊癌（GBca）侵犯肝脏1例，肝内胆管乳头状瘤1例，肝内胆管结石1例。结果 16例中除2例患者于肝切除术后第144天和第351天确诊为慢性PH-PVT外，其余14例患者PH-PVT确诊时间为术后第1～24天，平均为第9天。4例患者PH-PVT形成后无任何临床症状，9例出现不明原因的发热，4例出现腹痛和恶心症状，3例出现腹胀、呕血、便血和黄疸症状，5例最终发展为肝性脑病和肝衰竭。经抗凝、溶栓和手术等治疗后，8例好转出院，8例死亡。结论 PH-PVT发生的危险因素众多，可经增强CT确诊，其治疗方法包括抗凝、溶栓和手术取栓等。目前没有明确的PH-PVT预测和预防方法，早发现、早治疗是改善患者预后的关键。 |
| 关键词: 肝切除术后门静脉血栓 诊断 治疗 预后 |
| DOI：10.3969/j.issn.1674-3806.2022.01.10 |
| 分类号:R 657.3 |
| 基金项目: |
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| Analysis of diagnosis and treatment of post-hepatectomy portal vein thrombosis in 16 cases |
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CHEN Bao-jun, TONG Xuan, FAN Hai-ning, et al.
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Graduate School, Qinghai University, Xining 810000, China
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| Abstract: |
| ［Abstract］ Objective To summarize the diagnosis and treatment mothods and prognosis of post-hepatectomy portal vein thrombosis(PH-PVT) in 16 cases. Methods The clinical data of 16 patients with PH-PVT admitted to Beijing Tsinghua Changgung Hospital from February 2015 to February 2021 were retrospectively analyzed, and their clinical characteristics and diagnosis and treatment process were summarized. All the 16 cases were confirmed by enhanced CT examination. Among the 16 cases, there were 7 males and 9 females, aged 34-74(58.44±11.29)years old, including 4 cases of hepatocellular carcinoma(HCC), 8 cases of perihilar cholangiocarcinoma(PHCC), 1 case of cholangiocarcinoma, 1 case of gallbladder cancer(GBca) invading the liver, 1 case of intrahepatic bile duct papilloma and 1 case of intrahepatic bile duct stones. Results Among the 16 cases, except for 2 patients who were diagnosed with chronic PH-PVT on day 144 and day 351 after hepatectomy, the other 14 patients had the time of diagnosis of PH-PVT from day 1 to day 24 after the operation, with an average of 9th day. After the formation of PVT, 4 patients had no clinical symptoms; 9 patients had unexplained fever; 4 patients had abdominal pain and nausea; 3 patients had abdominal distension, hematemesis, blood in the stool and jaundice symptoms, and 5 patients eventually developed hepatic encephalopathy and liver failure. After anticoagulant, thrombolytic and surgical treatments, 8 cases were improved and discharged, and 8 cases died. Conclusion There are many risk factors for PH-PVT.PH-PVT can be diagnosed by enhanced CT, and its treatment methods include anticoagulation, thrombolysis and surgical thrombus removal. At present, there is no clear method to predict and prevent PH-PVT, and early detection and early treatment are the keys to improving the prognosis of the patients. |
| Key words: Post-hepatectomy portal vein thrombosis(PH-PVT) Diagnosis Treatment Prognosis |
