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原帖由 hawkson 于 2010-2-20 14:54 发表
虽然时间有点晚了,但还是要祝411、GZ版主,各位战友及其为爱奔波的亲人们,新的一年里一切顺顺当当,大吉大利!十分感谢桃花的“样板工程”,年前虽然来去匆匆,不过还是照样实施了一下,现在情况不错。一句话总结:一场手术改变我对 ...
hawkson战友发现慢性乙型肝炎、脾脏肿大14年,2003年接受干扰素、拉米夫定抗病毒治疗,后肝功能正常自行停药。
手术中发现明显的结节性肝硬化。
这提示我们,乙肝抗病毒治疗的治疗终点,是HBVers需要高度重视。随意停药、甚至是医生指导下的停药,都可能造成不可逆的严重肝硬化。
术后情况:
1. 1-2天<38度的低热;
2. 2天轻度左上腹疼痛,口服布洛芬缓解;
3. 3天间歇性呃逆,舌下含化 盐酸异山梨酯片后消失。
术后CT血管重建发现脾静脉血栓,门静脉通畅;没有腹水和胸腔积液。
已经给予适当抗凝+抗血小板药物治疗(根据以下文献,不接受抗凝治疗,脾静脉血栓也能自行消失或改善)。建议3个月后复查。
术后2周的肝功能等实验室化验,提示相比术前异常的高胆红素血症、凝血异常、血小板减少和白细胞减少症,都有了明显改善。
肝功能的改善,应该是得益于“脾动脉盗血综合征”得到了纠正(改日整理后贴出),肝动脉有效氧供增加从而改善肝细胞功能。252楼显示桃花姑娘的肝动脉变异,这种获益相对不充分。
Acta Radiol. 2009 Jul;50(6):617-23.
Risk factors and clinical course of portal and/or splenic vein thrombosis after partial splenic embolization.
Matsumoto T, Yamagami T, Terayama K, Kato T, Hirota T, Yoshimatsu R, Miura H, Ito H, Okanoue T, Nishimura T.
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan. [email protected]
BACKGROUND: Although portal and/or splenic vein thrombosis after partial splenic embolization (PSE) is a well-known complication, few reports evaluating risk factors have been published. PURPOSE: To investigate risk factors and clinical course of portal and/or splenic vein thrombosis after PSE. MATERIAL AND METHODS: Sixteen patients with severe hypersplenism underwent PSE between March 2005 and April 2008. The correlation between portal and/or splenic vein thrombosis after PSE detected on multidetector row CT (MDCT) and various factors were retrospectively reviewed. Further, the clinical course of portal and/or splenic vein thrombosis after PSE was observed on follow-up MDCT. RESULTS: Splenic vein thrombosis was detected in eight patients (50%) on MDCT images taken within 9 days after PSE. In one, the thrombosis also involved the portal vein. The infarct volume was identified as a significant risk factor for portal and/or splenic vein thrombosis (P=0.046). In all but one patient, splenic vein thrombosis resolved completely or improved without anticoagulation therapy. In this patient, both portal and splenic vein thrombosis developed after PSE, and anticoagulation therapy was necessary. CONCLUSION: It is suggested that a large splenic infarct volume is a risk factor for portal and/or splenic vein thrombosis after PSE. Indications for treatment of thrombosis of the portal vein system after PSE may be limited to patients with portal vein thrombosis.
PMID: 19449229 [PubMed - indexed for MEDLINE]
主要意思:
部分性脾栓塞(非上面的脾动脉主干栓塞)脾静脉和/或门静脉血栓发生率50%。
除了1例,所有血栓病人都不需要抗凝治疗,脾静脉血栓完全消失或改善。
1例合并门静脉和脾静脉血栓者,需要抗凝治疗。 |
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