肝移植时代：解剖性脾脏切除术联合抗凝治疗预防脾切除术后门脉血栓形成

发布时间：2018-06-15 03:37

本文选题：门静脉高压 + 解剖性脾脏切除手术　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：肝硬化合并有门静脉系统高压的患者,在行脾脏切除手术后,门静脉血栓形成是最常见的并发症之一,同时给将来可能需要的肝脏移植带来困难。本文回顾性分析解剖性脾脏切除手术联合早期抗凝治疗对门静脉高压患者脾脏切除手术后门脉血栓形成的预防作用。方法：从2010年1月到2013年12月,我校附一院肝胆外科共有136例因肝硬化所致门静脉高压症而行脾脏切除手术的患者。本文对他们进行了回顾性分析。基于他们各自采取的术式不同和是否应用早期抗凝治疗,我们将他们分为三组：A组46例患者,都采用传统脾脏切除手术,术后早期未予以抗凝治疗；B 40例患者,全部都采用传统脾脏切除手术,但术后早期予以抗凝治疗；C组50例患者,一致采用解剖脾脏切除手术,手术后12小时内给予抗凝治疗。术后观察患者凝血功能、脾静脉及门静脉血栓形成、腹腔出血、胰漏及腹腔感染等情况。结果：A组门脉血栓发生率约为41.3%(19/46),B组约为20.0%(8/40),同A组相比,存在明显的差异(p值0.05)；而C组则为4.0%(2/50),与A组及B组相比存在明显的差异(p值各为0.00、0.021)。虽然患者存在肝硬化、门静脉系统高压症,但术后早期抗凝治疗对患者凝血功能及腹腔出血无明显影响(p值0.05)。解剖性脾脏切除手术可以减少术后出血、胰漏及腹腔感染并发症的发生(p值0.05)。结论：解剖性脾切除联合术后早期抗凝治疗,可以减少门脉高压患者脾脏切除手术后门脉血栓形成,有利于患者将来可能需要的肝脏移植治疗。
[Abstract]:Objective: portal vein thrombosis is one of the most common complications in patients with cirrhosis complicated with portal hypertension after splenectomy. The preventive effects of anatomic splenectomy combined with early anticoagulant therapy on portal vein thrombosis after splenectomy in patients with portal hypertension were analyzed retrospectively. Methods: from January 2010 to December 2013, 136 patients with portal hypertension caused by cirrhosis underwent splenectomy. This paper makes a retrospective analysis of them. We divided them into three groups, 46 patients in group A, who were treated with traditional splenectomy, and 40 patients who were not treated with anticoagulant therapy at the early stage of operation, based on their different operation methods and whether they were treated with early anticoagulant therapy. All patients were treated with traditional splenectomy, but 50 patients in group C were treated with anticoagulant therapy early after operation. All patients were treated with dissected splenectomy and treated with anticoagulant therapy within 12 hours after operation. The coagulation function, thrombosis of splenic vein and portal vein, abdominal hemorrhage, pancreatic leakage and abdominal infection were observed after operation. Results the incidence of portal thrombosis in group A was about 41.3% and that in group B was about 20.0 / 40%. There was a significant difference between group A and group A in the incidence of portal thrombosis (P = 0.05), but in group C it was 4.00% 50%, and the difference between group A and group B was 0.000.021 (P = 0.000.021). Although the patients had cirrhosis and portal hypertension early anticoagulant therapy had no significant effect on coagulation function and abdominal bleeding. Anatomical splenectomy can reduce postoperative bleeding, pancreatic leakage and abdominal infection complications (P = 0.05). Conclusion: anatomical splenectomy combined with early anticoagulant therapy can reduce portal thrombosis after splenectomy in patients with portal hypertension.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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