Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Surgery, Uijeongbu St. Mary's Hospital, Catholic University, Uijeongbu, South Korea.
J Gastrointest Surg. 2020 Feb;24(2):396-404. doi: 10.1007/s11605-018-04085-w. Epub 2019 Jan 22.
Portomesenteric venous thrombosis (PMVT) can occur after colorectal surgery. Most previous studies included patients with various diseases, especially inflammatory bowel disease. The prevalence and clinical significance of PMVT developing after surgery for colorectal cancer (CRC) remain unclear.
Consecutive patients who underwent resection for CRC between June 2003 and April 2016 were retrospectively analyzed. Postoperative PMVT was diagnosed based on pre- and postoperative computed tomography (CT).
Postoperative PMVT developed in 10 (0.24%) of 4232 patients who underwent resection for CRC. One patient had alcoholic liver cirrhosis, whereas nine did not have prior or current liver disease. PMVT in eight patients was detected within 2 weeks after surgery by CT, performed to evaluate non-specific symptoms such as mild fever and abdominal pain, or performed postoperatively after deep pelvic dissection. PMVT in the remaining two asymptomatic patients was diagnosed following surveillance CT 3 and 7 months after surgery, respectively. PMVT in the patient with liver cirrhosis was detected 13 days after surgery and found to involve the main portal vein, causing hyperbilirubinemia and requiring emergency thrombectomy with thrombolysis. PMVT in the nine patients without liver disease was resolved by anticoagulation therapy or conservative care without long-term complications.
PMVT after CRC surgery is likely an early postoperative event in most patients. The incidence of clinically significant PMVT in patients with CRC may be lower than previously reported. CT was reliable in the diagnosis and follow-up of these patients. Most patients with PMVT can be managed conservatively without serious long-term morbidity.
门静脉肠系膜静脉血栓形成（PMVT）可发生于结直肠手术后。大多数既往研究纳入了患有多种疾病的患者，尤其是炎症性肠病患者。结直肠癌（CRC）手术后 PMVT 的发生率和临床意义尚不清楚。
回顾性分析 2003 年 6 月至 2016 年 4 月期间行结直肠切除术的连续患者。基于术前和术后计算机断层扫描（CT）诊断术后 PMVT。
4232 例行结直肠切除术的患者中，术后发生 PMVT 10 例（0.24%）。1 例患者患有酒精性肝硬化，9 例患者术前或当前无肝脏疾病。8 例患者的 PMVT 在术后 2 周内通过 CT 检测到，CT 用于评估非特异性症状，如轻度发热和腹痛，或在深部盆腔解剖后术后进行。另两名无症状患者的 PMVT 在术后 3 个月和 7 个月分别通过监测 CT 诊断。肝硬化患者的 PMVT 在术后 13 天被检测到，涉及主门静脉，导致高胆红素血症，需要紧急血栓切除术和溶栓治疗。9 例无肝脏疾病的患者的 PMVT 通过抗凝治疗或保守治疗解决，无长期并发症。
CRC 手术后的 PMVT 可能是大多数患者的早期术后事件。CRC 患者中具有临床意义的 PMVT 的发生率可能低于先前报道。CT 对这些患者的诊断和随访是可靠的。大多数 PMVT 患者可通过保守治疗而无严重的长期发病率。
