门静脉血栓的治疗？手术的风险？

bannatech

寻求帮助

我父亲得了门静脉血栓，引起胆管堵死。主治医生表示只能安装支架或切除手术，但其医院做此手术把握不大，请问在哪儿做手术比较好？做此手术有哪些风险？有没有更好的方法？
我手机号为15000546288 。肯请知道的人告诉我，不胜感激。

踏雪飞鸿

如果情况还好,建议中医试试,我原来就是血栓,目前经过一年多的中医治疗,已经化解了.可以搜索我以前关于血栓的帖子

liver_GZ

原帖由 bannatech 于 2009-4-29 23:55 发表
寻求帮助

我父亲得了门静脉血栓，引起胆管堵死。主治医生表示只能安装支架或切除手术，但其医院做此手术把握不大，请问在哪儿做手术比较好？做此手术有哪些风险？有没有更好的方法？
我手机号为15000546288 。肯请知道的人告诉 ...

“门静脉血栓，引起胆管堵死”

对以上的诊断提出疑虑：
两者之间有因果关系？那应该诊断“门脉性胆道病”（portal biliopathy），即门静脉血栓形成后，发生门静脉海绵样改变，高压、扩张迂曲的门静脉侧枝压迫胆管导致梗阻性黄疸。

这是一个相对国内认识较少的病症，多年前我曾经在一专著系统描述过。

如果是“门脉性胆道病”（portal biliopathy），则治疗上可以有的放矢，首选内镜下的治疗，比如内镜下胆道支架置入术。手术操作是一个高风险操作，失血量较多。

请提供详细病例资料：
比如原发疾病是病毒性肝炎导致的肝硬化？还是胆系结石或原发性胆汁性肝硬化？有无胆道结石或胆管扩张？
目前肝功能水平？胆红素水平（总胆红素、直接胆红素）？凝血状况？

[ 本帖最后由 liver_GZ 于 2009-5-3 20:04 编辑 ]

liver_GZ

可以用“portal biliopathy”作为主题词在medline搜索。
提供一篇文献：
Eur J Gastroenterol Hepatol. 2009 Feb;21(2):206-13.Related Articles, Links
Symptomatic portal biliopathy: a single centre experience from the UK.

Htun Oo Y, Olliff S, Haydon G, Thorburn D.

Liver Research Laboratory, Institute of Biomedical Research, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.

BACKGROUND AND METHODS: Biliary obstruction as a consequence of portal biliopathy, because of extrahepatic portal vein occlusion is an uncommon cause of biliary disease in the western world. We reviewed all patients presenting to the Regional Liver Transplant Unit in Birmingham, UK with symptomatic portal biliopathy between 1992 and 2005 and report the presentation, investigation, management and outcome of these complex patients. RESULTS: Thirteen patients with symptomatic portal biliopathy were followed up for a median of 2 years (range 1-18 years). Jaundice was the presenting feature in all cases and was associated with bile duct stones or debris in 77% (10 of 13) of cases. Successful treatment of biliary problems was achieved by biliary decompression in six cases (metallic stent=three, plastic stent=one, combined procedure=one and sphincterectomy=one) and portal decompression in three cases (transjugular intrahepatic portosystemic shunt=two, meso-caval shunt=one). Successful biliary drainage could not be achieved endoscopically or by portal decompression in one case that was accepted for combined liver and small bowel transplantation. Three patients had spontaneous resolution without recurrence over the follow-up period. Ten patients (77%) experienced gastrointestinal bleeding. Two deaths over the follow-up period occurred; both were associated with portal hypertensive bleeding. CONCLUSION: Endoscopic management (sphincterectomy and stone extraction or stent insertion) is effective initial therapy for patients with symptomatic portal biliopathy. In the case of persistent biliary obstruction porto-systemic shunting (transjugular intrahepatic portosystemic shunt or surgical) should be considered, however, the extent of vascular thrombosis precludes this in most cases.

xjqh2000

我是吃中药治好了门静脉血栓！论坛里已经上传了文章 。

mendez

我母亲也有血栓了，庆幸的是初期，医院建议胃镜治疗，向各位老师病友咨询，初期血栓胃镜治疗是否合适

mendez

肝功正常，2对半阴性，门静脉有血栓，医院建议胃镜治疗。
向版主请教这样的处理是否合适。