Yoshiya Shohei, Shirabe Ken, Nakagawara Hidekazu, Soejima Yuji, Yoshizumi Tomoharu, Ikegami Toru, Yamashita Yo-Ichi, Harimoto Norifumi, Nishie Akihiro, Yamanaka Takeharu, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
World J Surg. 2014 Jun;38(6):1491-7. doi: 10.1007/s00268-013-2440-8.
Although various complications after hepatectomy have been reported, there have been no large studies on postoperative portal vein thrombosis (PVT) as a complication. This study evaluated the incidence, risk factors, and clinical outcomes of PVT after hepatectomy.
The preoperative and postoperative clinical characteristics of patients who underwent hepatectomy were retrospectively analyzed.
A total of 208 patients were reviewed. The incidence of PVT after hepatectomy was 9.1 % (n = 19), including main portal vein (MPV) thrombosis (n = 7) and peripheral portal vein (PPV) thrombosis (n = 12). Patients with MPV thrombosis had a significantly higher incidence of right hepatectomy (p < 0.001), larger resection volume (p = 0.003), and longer operation time (p = 0.021) than patients without PVT (n = 189). Multivariate analysis identified right hepatectomy as a significant independent risk factor for MPV thrombosis (odds ratio 108.9; p < 0.001). Patients with PPV thrombosis had a significantly longer duration of Pringle maneuver than patients without PVT (p = 0.002). Among patients who underwent right hepatectomy, those with PVT (n = 6) had a significantly lower early liver regeneration rate than those without PVT (n = 13; p = 0.040), and those with PVT had deterioration of liver function on postoperative day 7. In all patients with MPV thrombosis who received anticoagulation therapy, PVT subsequently resolved.
Postoperative PVT after hepatectomy is not rare. It is closely related to delayed recovery of liver function and delayed liver regeneration.
尽管已报道了肝切除术后的各种并发症，但尚未有关于术后门静脉血栓形成（PVT）这一并发症的大型研究。本研究评估了肝切除术后PVT的发生率、危险因素及临床结局。
对接受肝切除术患者的术前和术后临床特征进行回顾性分析。
共纳入208例患者进行评估。肝切除术后PVT的发生率为9.1%（n = 19），包括门静脉主干（MPV）血栓形成（n = 7）和门静脉分支（PPV）血栓形成（n = 12）。与无PVT的患者（n = 189）相比，MPV血栓形成患者右肝切除术的发生率显著更高（p < 0.001），切除体积更大（p = 0.003），手术时间更长（p = 0.021）。多因素分析确定右肝切除术是MPV血栓形成的显著独立危险因素（比值比108.9；p < 0.001）。PPV血栓形成患者的肝门阻断时间显著长于无PVT的患者（p = 0.002）。在接受右肝切除术的患者中，发生PVT的患者（n = 6）早期肝再生率显著低于未发生PVT的患者（n = 13；p = 0.040），且发生PVT的患者在术后第7天肝功能恶化。在所有接受抗凝治疗的MPV血栓形成患者中，PVT随后均得到缓解。
肝切除术后的PVT并不罕见。它与肝功能恢复延迟和肝再生延迟密切相关。
