Diagnosis and Treatment for Extensive Portal Vein Thrombosis: A Case Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 刘坤 ,  林斌

徐州医学院附属宿迁医院南京鼓楼医院集团宿迁市人民医院普外科（江苏宿迁 223800）;

Corresponding author：

林斌, Email: linbin4486@163.com

Keywords：

门静脉血栓形成/肠系膜上静脉血栓形成; 抗凝治疗; 溶栓治疗; 介入治疗

DOI：

10.7507/1007-9424.20140120

Video：

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目的探讨广泛门静脉血栓形成（portal vein thrombosis，PVT）的诊治经验。方法回顾性分析笔者所在医院2004年1月至2012年12月期间收治的7例广泛PVT患者的临床资料。结果按Yerdel’s分级7例患者属Ⅲ～Ⅳ级；男4例，女3例；年龄28～54岁，中位年龄45岁；起病至就诊时间4～10 d，平均6.9 d。表现为上腹痛3例，全腹痛、腹胀4例，血便2例，休克1例，腰背痛1例，恶心、呕吐3例。查体：有腹膜炎体征3例，左下腹压痛1例，腹水征阳性3例，肠鸣音消失2例，减弱1例。2例行D-二聚体检查均升高。所有患者超声检查均提示门静脉血栓形成、累及肠系膜上静脉。给予抗凝、祛聚、溶栓等基础治疗；1例经肠系膜上动脉导管溶栓，2例手术切除坏死肠管，其中1例同时行脾切除术。1例术后发生肠瘘，经保守治疗治愈；3例患者发生门静脉高压性胃肠病，口服普萘洛尔治疗。结论早期行血浆D-二聚体及影像学检查，尽早行抗凝治疗，无禁忌时行溶栓或介入治疗以及实时手术治疗，PVT患者可有较好的预后。

Citation： 刘坤, 林斌. Diagnosis and Treatment for Extensive Portal Vein Thrombosis: A Case Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(4): 492-494. doi: 10.7507/1007-9424.20140120 Copy

1.	钱爱民, 李晓强, 桑宏飞, 等.介入联合手术治疗门静脉血栓形成7例[J].中国微创外科杂志, 2007, 7(5):450-451.
2.	陈国富, 范国华.脾切除术后门静脉系统血栓形成的临床分析[J].中国普外基础与临床杂志, 2012, 19(6):649-652.
3.	Chawla Y, Duseja A, Dhiman RK. Review article:the modern management of portal vein thrombosis[J]. Aliment Pharmacol Ther, 2009, 30(9):881-894.
4.	Ponziani FR, Zocco MA, Campanale C, et al. Portal vein thrombosis:insight into physiopathology, diagnosis, and treatment[J]. World J Gastroenterol, 2010, 16(2):143-155.
5.	卢翔, 赵青川, 韩国宏, 等.肝硬化门静脉高压症术后门静脉血栓形成危险因素研究[J].中国实用外科杂志, 2013, 33(3):205-207.
6.	刘坤, 林斌.门静脉血栓形成的治疗进展[J].中国血管外科杂志:电子版, 2012, 4(2):124-127.
7.	Furlan A, Marin D, Cabassa P, et al. Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI:intermodality agreement and comp-arison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines[J]. Eur J Radiol, 2012, 81(9):2099-2105.
8.	郭银燕. D-二聚体在诊断肝硬化门静脉血栓形成中的应用价值[J].临床肝胆病杂志, 2010, 26(3):304-305.
9.	Hoekstra J, Janssen HL. Vascular liver disorders (Ⅱ):portal vein thrombosis[J]. Neth J Med, 2009, 67(2):46-53.
10.	Luca A, Caruso S, Milazzo M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis[J]. Radiology, 2012, 265(1):124-132.
11.	中华医学会外科学分会血管外科学组, 李晓强, 王深明.深静脉血栓形成的诊断和治疗指南(第二版)[J].中华普通外科杂志, 2012, 27(7):605-607.
12.	徐健, 陈建华, 夏茜, 等.肠系膜上静脉血栓形成致肠坏死的诊治分析(附32例报道)[J].中国普外基础与临床杂志, 2012, 19(4):406-409.
13.	陈雄.经皮肝穿刺门静脉置管溶栓治疗急性肠系膜上静脉血栓(附7例报道)[J].中国普外基础与临床杂志, 2010, 17(7):731-734.
14.	李说, 颜志平, 罗建均, 等.经TIPS途径治疗急性、亚急性门静脉血栓临床疗效[J].介入放射学杂志, 2009, 18(8):581-583.
15.	Senzolo M, M Sartori T, Rossetto V, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis[J]. Liver Int, 2012, 32(6):919-927.

1. 钱爱民, 李晓强, 桑宏飞, 等.介入联合手术治疗门静脉血栓形成7例[J].中国微创外科杂志, 2007, 7(5):450-451.
2. 陈国富, 范国华.脾切除术后门静脉系统血栓形成的临床分析[J].中国普外基础与临床杂志, 2012, 19(6):649-652.
3. Chawla Y, Duseja A, Dhiman RK. Review article:the modern management of portal vein thrombosis[J]. Aliment Pharmacol Ther, 2009, 30(9):881-894.
4. Ponziani FR, Zocco MA, Campanale C, et al. Portal vein thrombosis:insight into physiopathology, diagnosis, and treatment[J]. World J Gastroenterol, 2010, 16(2):143-155.
5. 卢翔, 赵青川, 韩国宏, 等.肝硬化门静脉高压症术后门静脉血栓形成危险因素研究[J].中国实用外科杂志, 2013, 33(3):205-207.
6. 刘坤, 林斌.门静脉血栓形成的治疗进展[J].中国血管外科杂志:电子版, 2012, 4(2):124-127.
7. Furlan A, Marin D, Cabassa P, et al. Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI:intermodality agreement and comp-arison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines[J]. Eur J Radiol, 2012, 81(9):2099-2105.
8. 郭银燕. D-二聚体在诊断肝硬化门静脉血栓形成中的应用价值[J].临床肝胆病杂志, 2010, 26(3):304-305.
9. Hoekstra J, Janssen HL. Vascular liver disorders (Ⅱ):portal vein thrombosis[J]. Neth J Med, 2009, 67(2):46-53.
10. Luca A, Caruso S, Milazzo M, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis[J]. Radiology, 2012, 265(1):124-132.
11. 中华医学会外科学分会血管外科学组, 李晓强, 王深明.深静脉血栓形成的诊断和治疗指南(第二版)[J].中华普通外科杂志, 2012, 27(7):605-607.
12. 徐健, 陈建华, 夏茜, 等.肠系膜上静脉血栓形成致肠坏死的诊治分析(附32例报道)[J].中国普外基础与临床杂志, 2012, 19(4):406-409.
13. 陈雄.经皮肝穿刺门静脉置管溶栓治疗急性肠系膜上静脉血栓(附7例报道)[J].中国普外基础与临床杂志, 2010, 17(7):731-734.
14. 李说, 颜志平, 罗建均, 等.经TIPS途径治疗急性、亚急性门静脉血栓临床疗效[J].介入放射学杂志, 2009, 18(8):581-583.
15. Senzolo M, M Sartori T, Rossetto V, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis[J]. Liver Int, 2012, 32(6):919-927.

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Diagnosis and Treatment for Extensive Portal Vein Thrombosis: A Case Review

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