中国实用外科杂志

中国实用外科杂志

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肝细胞癌肝切除术后门静脉血栓形成10例诊治分析

李鹏鹏，田    涛，王孟超，王    剑，刘    辉，林    川，潘泽亚，周伟平   

  1. 第二军医大学附属东方肝胆外科医院肝外三科，上海 200438
  • 出版日期:2017-04-01 发布日期:2017-03-31

  • Online:2017-04-01 Published:2017-03-31

摘要：

目的    探讨肝细胞癌肝切除术后门静脉血栓形成的可能原因及预防措施。方法    回顾性分析2010年1月至2013年12月第二军医大学附属东方肝胆外科医院收治的10例肝细胞癌肝切除术后门静脉血栓形成的病人资料，包括一般资料、既往病史、术前检查、术中情况、术后检查诊断及治疗措施等。结果    门静脉血栓确诊时间为术后3～15 d，平均为6.6 d。术后9例病人出现肝功能迅速恶化，表现为术后丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）逐渐下降后突然升高，确诊当日TBIL为159.4（9.5~472.9）μmol/L，ALT为1175.4（73.9~5485）U/L。6例病人术后行D-二聚体检查，其中5例（83.3%）明显升高（＞20 mg/L），1例轻度升高（≤20 mg/L）。10例均常规术后使用止血药物，且均于确诊门静脉血栓后开始使用低分子肝素抗凝治疗。3例抗凝治疗后门静脉血流恢复，好转出院；6例因急性肝功能衰竭死亡；1例因急性肾功能衰竭、感染性休克死亡。结论    肝细胞癌肝切除术后门静脉血栓形成可以导致病人术后肝功能衰竭甚至死亡，故建议肝切除术后宜慎用止血药并早期抗凝。

关键词: 肝细胞癌, 肝切除术, 门静脉血栓形成

Abstract:

The analysis of 10 cases of portal vein thrombosis after liver resection for hepatocellular carcinoma        LI Peng-peng，TIAN Tao，WANG Meng-chao，et al. The Third Department of Hepatic Surgery Eastern Hepatobiliary Surgery Hospital，the Second Military Medical University，Shanghai 200438，China
Corresponding author：ZHOU Wei-ping，E-mail：ehphwp@ 126.com
Abstract    Objective    To explore the possible reasons and preventive measures of portal vein thrombosis after hepatectomy in patients with hepatocellular carcinoma. Methods    The data of 10 patients with hepatic portal vein thrombosis after liver resection were retrospectively analyzed in Eastern Hepatobiliary Surgery Hospital from January 2010 to December 2013. Data include general information，past medical history, preoperative examination, intraoperative data, postoperative examination results, treatment measures and prognosis. Results    Portal vein thrombosis was diagnosed 3-15 days postoperatively, with an average of 6.6 days. There were 9 patients of rapid deterioration of liver function (manifested as ALT, TBIL significantly increased) after surgery. Six patients had D-dimer examination, which was significantly higher (> 20 mg/L) in 5 cases, mild increase in 1 cases. D-dimer increased significantly in 83.3%. All 10 patients were treated with hemostatic agents. All 10 patients underwent anticoagulation with low-molecular-weight heparins after diagnosis of portal vein thrombosis. Three patients’ portal vein blood flow recovered after anticoagulation treatment and then were discharged after further improvement. Six patients died of acute liver failure and 1 patient died of acute renal failure and septic shock. Conclusion    Portal vein thrombosis is one of the reasons of postoperative liver failure and death. We recommend hemostatic agents should be used with caution and The anti-coagulation therapy can be early administrated after operation.

Key words: hepatocellular carcinoma, hepatectomy, portal vein thrombosis