脾切除术后骨髓增殖性疾病广泛肠系膜静脉血栓形成致右心和肺血栓栓塞症。
Right heart and pulmonary thromboembolism from extensive splanchnic vein thrombosis after splenectomy for myeloproliferative disease.
机构信息
Department of Respiratory Medicine, Monaldi Hospital, University Federico II of Naples, Naples, Italy.
出版信息
Heart Lung. 2012 Mar-Apr;41(2):188-91. doi: 10.1016/j.hrtlng.2011.03.003.
BACKGROUND
Splenectomy is a risk factor for both portal-vein and chronic thromboembolic pulmonary hypertension. The underlying mechanism is unclear, but may involve a hypercoagulable state.
METHODS
We describe 1 patient with polycythemia vera who developed extensive portal thrombosis of the portal, suprahepatic, and inferior cava veins, leading to right heart thromboembolism, with a resultant pulmonary embolism subsequent to splenectomy despite heparin prophylaxis.
RESULTS
In this patient, several mechanisms may have played a role, including perioperative stress, thrombocytosis, thrombophilia, and associated chronic liver disease. Nevertheless, combined treatment with intravenous heparin and thrombolysis and the myeloproliferative inhibitor hydroxyurea was associated with a favorable outcome.
CONCLUSION
The risk of pulmonary thromboembolic complications and their management after splenectomies for hematologic disease warrant further study.
背景
脾切除术是门静脉高压和慢性血栓栓塞性肺动脉高压的一个危险因素。其潜在机制尚不清楚，但可能涉及高凝状态。
方法
我们描述了 1 例真性红细胞增多症患者，该患者发生广泛的门静脉、肝上和肝下腔静脉血栓形成，导致右心血栓栓塞，尽管预防性使用肝素，但脾切除术后仍发生肺栓塞。
结果
在本例患者中，多种机制可能起作用，包括围手术期应激、血小板增多、血栓形成倾向和相关的慢性肝病。然而，静脉内肝素和溶栓联合骨髓增生抑制剂羟基脲治疗与良好的预后相关。
结论
血液疾病脾切除术后发生肺血栓栓塞并发症及其处理的风险值得进一步研究。
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