早期应用低分子肝素预防腹腔镜脾切断流术后门静脉血栓形成的研究

发布时间：2018-08-10 19:56

【摘要】：目的：探索腹腔镜脾切断流术(LSED)后早期预防性应用低分子肝素(LMWH)对于预防术后门静脉血栓(PVST)形成的疗效及安全性。方法：回顾性分析浙江大学附属第一医院肝胆胰外科自2012年1月至2015年1月因患肝硬化门脉高压症行腹腔镜脾切断流术的患者,其中符合标准并有完整病例资料的患者共41例,入院完善患者一般资料及各项相关检查,将患者肝功能调整至Child-Pugh分级B级以上,并实施LSED手术,根据患者术后是否早期预防性应用低分子肝素抗凝治疗分为试验组(LMWH组)及对照组：LMWH组患者25例,其中男性19例,女性6例；对照组16例,其中男性10例,女性6例。术后定期复查患者肝功能及凝血指标,并常规于术后第1天、出院前及术后2个月行彩超检查,以明确有无PVST形成。出现门静脉系统的血栓,无论在脾静脉、肠系膜上静脉、肠系膜下静脉或门静脉主干任意处部分或完全性附壁血栓,均可诊断为PVST.应用SPSS20.0软件包进行统计学分析,计量资料以x±s表示,两组间比较采用独立样本t检验；两组间分类计数资料采用χ2检验或χ2检验的连续性校正进行数据分析,以P0.05为差异有统计学意义。结果：对照组与LMWH组比较性别、年龄等一般情况,手术前及术后肝功能、凝血指标无明显差异(P0.05)。两组患者在院期间,对照组术后PVST发生率为56.25%,LMWH组术后PVST发生率为12%,两组患者在住院期间发生的PVST的概率的差异显著,具有统计学意义(P0.05)；LMWH组未出现出血等与低分子肝素使用相关的并发症；术后2个月进行复查彩超检查,对照组患者PVST发生率为68.75%,LMWH组患者发生PVST发生率为16%,两组患者在术后2个月内发生PVST的概率的差异显著,具有统计学意义(P0.05)。结论：腹腔镜脾切断流术后早期预防性行低分子肝素抗凝治疗可安全有效地预防门静脉血栓形成,并不会增加患者术后出血等并发症的风险。
[Abstract]:Objective: to investigate the efficacy and safety of early prophylactic application of low molecular weight heparin (LMWH) (LMWH) in prevention of portal vein thrombosis (PVST) after laparoscopic splenectomy (LSED). Methods: the patients undergoing laparoscopic splenectomy in the Department of Hepatobiliary and Pancreatic surgery in the first affiliated Hospital of Zhejiang University from January 2012 to January 2015 were retrospectively analyzed. There were 41 patients who met the standard and had complete case data. The patients' general data and relevant examinations were improved. The liver function of the patients was adjusted to Child-Pugh grade B or above, and LSED operation was performed. According to the early prophylactic use of low molecular weight heparin anticoagulant therapy, the patients were divided into two groups: the experimental group (LMWH group) and the control group (control group). There were 19 males and 6 females in the control group, and 16 patients in the control group (10 males and 6 females). The liver function and coagulation parameters were reexamined regularly after operation. Color Doppler ultrasonography was performed on the first day of operation, before discharge and 2 months after operation to determine whether or not PVST was formed. Portal vein thrombosis can be diagnosed as PVST whether in splenic vein superior mesenteric vein inferior mesenteric vein or portal vein at any part or complete mural thrombus. The statistical analysis was carried out by SPSS20.0 software package, the measurement data were expressed as x 卤s, and the independent sample t test was used for the comparison between the two groups, and the data were analyzed by the continuity correction of 蠂 2 test or 蠂 2 test for the classified counting data between the two groups. P0.05 as the difference was statistically significant. Results: there was no significant difference between control group and LMWH group in sex, age, liver function and coagulation index before and after operation (P0.05). The incidence of postoperative PVST in the control group was 56.25%. The incidence of postoperative PVST in the two groups was 12. The probability of PVST in the two groups was significantly different (P0.05). There were no complications associated with low molecular weight heparin use in LMWH group, and color Doppler ultrasonography was performed 2 months after operation. The incidence of PVST in the control group was 68.75 and the incidence of PVST in the LMWH group was 16. There was significant difference in the probability of PVST in the two groups within 2 months after operation (P0.05). Conclusion: early prophylactic low molecular weight heparin anticoagulant therapy after laparoscopic splenectomy is safe and effective in preventing portal vein thrombosis and does not increase the risk of complications such as postoperative bleeding.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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