Gold Coast University Hospital, Queensland, Australia; University of Queensland, Brisbane, Australia.
Greenslopes Hospital, Brisbane, Australia.
Surg Obes Relat Dis. 2018 Mar;14(3):271-275. doi: 10.1016/j.soard.2017.12.010. Epub 2017 Dec 15.
Worldwide, the laparoscopic sleeve gastrectomy (LSG) is becoming the dominant bariatric procedure due to its reliable weight loss and low complication rate. Portomesenteric vein thrombosis (PVT) is an uncommon complication of LSG with an incidence of .3% to 1% and can lead to serious consequences, such as bowel ischemia and death.
This paper will present the presentation, risk factors, treatment, and long-term outcomes of patients who had PVT post-LSG.
Five bariatric centers in a private setting in Australia.
Retrospective data were collected from 5 bariatric centers across Australia from 2007 to 2016.
Across 5 centers, 5951 patients underwent LSG; 18 had recognized PVT (.3%). The mean body mass index was 41.8. Of patients, 39% had a history or family history of deep vein thrombosis. The average time to diagnosis was 13 days (range, 5-25). Treatment was nonoperative with anticoagulation in 94%. One patient required operative management with bowel resection. All patients were discharged on therapeutic anticoagulation. Mean total weight loss was 27.7% (14.8%-66.3%). Mean follow-up was 10 months. There were no mortalities. Given the low number of patients, no statistically significant data could be derived.
PVT is difficult to diagnose, with significant consequences. The presenting symptoms are nonspecific, and a high index of suspicion needs to be maintained. Cross-sectional imaging with computed tomography of the abdomen is recommended. Patients with PVT post-LSG without previous risk factors can be anticoagulated for 3 to 6 months with an international normalized ratio of 2 to 3.
在全球范围内，腹腔镜袖状胃切除术（LSG）因其可靠的减重效果和低并发症发生率而成为主导的减重手术。门腔静脉血栓形成（PVT）是 LSG 的一种罕见并发症，发病率为 0.3%至 1%，可导致严重后果，如肠缺血和死亡。
本文将介绍 LSG 后发生 PVT 的患者的临床表现、危险因素、治疗方法和长期预后。
澳大利亚一家私人机构的 5 个减重中心。
回顾性收集了澳大利亚 5 个减重中心 2007 年至 2016 年的资料。
在 5 个中心，5951 例患者接受了 LSG，18 例患者确诊为 PVT（0.3%）。患者的平均体重指数为 41.8。其中 39%的患者有深静脉血栓形成病史或家族史。平均诊断时间为 13 天（5-25 天）。94%的患者接受了非手术抗凝治疗。1 例患者需要手术治疗，行肠切除术。所有患者均在出院时接受了抗凝治疗。平均总减重为 27.7%（14.8%-66.3%）。平均随访时间为 10 个月。无死亡病例。由于患者数量较少，无法得出统计学上显著的数据。
PVT 诊断困难，后果严重。其临床表现无特异性，需要保持高度怀疑。推荐进行腹部 CT 等横断面成像检查。对于无既往危险因素的 LSG 后发生 PVT 的患者，可以抗凝治疗 3-6 个月，国际标准化比值为 2-3。
