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

Authors：

 劉坤 ,  林斌

徐州醫學院附屬宿遷醫院南京鼓樓醫院集團宿遷市人民醫院普外科（江蘇宿遷 223800）;

Corresponding?author：

林斌, Email: linbin4486@163.com

Keywords：

門靜脈血栓形成/腸系膜上靜脈血栓形成; 抗凝治療; 溶栓治療; 介入治療

DOI：

10.7507/1007-9424.20140120

Video：

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目的探討廣泛門靜脈血栓形成（portal vein thrombosis，PVT）的診治經驗。方法回顧性分析筆者所在醫院2004年1月至2012年12月期間收治的7例廣泛PVT患者的臨床資料。結果按Yerdel’s分級7例患者屬Ⅲ～Ⅳ級；男4例，女3例；年齡28～54歲，中位年齡45歲；起病至就診時間4～10 d，平均6.9 d。表現為上腹痛3例，全腹痛、腹脹4例，血便2例，休克1例，腰背痛1例，惡心、嘔吐3例。查體：有腹膜炎體征3例，左下腹壓痛1例，腹水征陽性3例，腸鳴音消失2例，減弱1例。2例行D-二聚體檢查均升高。所有患者超聲檢查均提示門靜脈血栓形成、累及腸系膜上靜脈。給予抗凝、祛聚、溶栓等基礎治療；1例經腸系膜上動脈導管溶栓，2例手術切除壞死腸管，其中1例同時行脾切除術。1例術后發生腸瘺，經保守治療治愈；3例患者發生門靜脈高壓性胃腸病，口服普萘洛爾治療。結論早期行血漿D-二聚體及影像學檢查，盡早行抗凝治療，無禁忌時行溶栓或介入治療以及實時手術治療，PVT患者可有較好的預后。

Citation： 劉坤, 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.	錢愛民, 李曉強, 桑宏飛, 等.介入聯合手術治療門靜脈血栓形成7例[J].中國微創外科雜志, 2007, 7(5):450-451.
2.	陳國富, 范國華.脾切除術后門靜脈系統血栓形成的臨床分析[J].中國普外基礎與臨床雜志, 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.	盧翔, 趙青川, 韓國宏, 等.肝硬化門靜脈高壓癥術后門靜脈血栓形成危險因素研究[J].中國實用外科雜志, 2013, 33(3):205-207.
6.	劉坤, 林斌.門靜脈血栓形成的治療進展[J].中國血管外科雜志:電子版, 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.	郭銀燕. D-二聚體在診斷肝硬化門靜脈血栓形成中的應用價值[J].臨床肝膽病雜志, 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.	中華醫學會外科學分會血管外科學組, 李曉強, 王深明.深靜脈血栓形成的診斷和治療指南(第二版)[J].中華普通外科雜志, 2012, 27(7):605-607.
12.	徐健, 陳建華, 夏茜, 等.腸系膜上靜脈血栓形成致腸壞死的診治分析(附32例報道)[J].中國普外基礎與臨床雜志, 2012, 19(4):406-409.
13.	陳雄.經皮肝穿刺門靜脈置管溶栓治療急性腸系膜上靜脈血栓(附7例報道)[J].中國普外基礎與臨床雜志, 2010, 17(7):731-734.
14.	李說, 顏志平, 羅建均, 等.經TIPS途徑治療急性、亞急性門靜脈血栓臨床療效[J].介入放射學雜志, 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. 錢愛民, 李曉強, 桑宏飛, 等.介入聯合手術治療門靜脈血栓形成7例[J].中國微創外科雜志, 2007, 7(5):450-451.
2. 陳國富, 范國華.脾切除術后門靜脈系統血栓形成的臨床分析[J].中國普外基礎與臨床雜志, 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. 盧翔, 趙青川, 韓國宏, 等.肝硬化門靜脈高壓癥術后門靜脈血栓形成危險因素研究[J].中國實用外科雜志, 2013, 33(3):205-207.
6. 劉坤, 林斌.門靜脈血栓形成的治療進展[J].中國血管外科雜志:電子版, 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. 郭銀燕. D-二聚體在診斷肝硬化門靜脈血栓形成中的應用價值[J].臨床肝膽病雜志, 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. 中華醫學會外科學分會血管外科學組, 李曉強, 王深明.深靜脈血栓形成的診斷和治療指南(第二版)[J].中華普通外科雜志, 2012, 27(7):605-607.
12. 徐健, 陳建華, 夏茜, 等.腸系膜上靜脈血栓形成致腸壞死的診治分析(附32例報道)[J].中國普外基礎與臨床雜志, 2012, 19(4):406-409.
13. 陳雄.經皮肝穿刺門靜脈置管溶栓治療急性腸系膜上靜脈血栓(附7例報道)[J].中國普外基礎與臨床雜志, 2010, 17(7):731-734.
14. 李說, 顏志平, 羅建均, 等.經TIPS途徑治療急性、亞急性門靜脈血栓臨床療效[J].介入放射學雜志, 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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