预防性抗凝治疗对肝硬化门静脉高压症术后门脉系统血栓形成的影响

发布时间：2018-11-23 15:24

【摘要】：目的:探讨肝硬化门静脉高压症行脾切除贲门周围血管离断术后预防性抗凝对门静脉系统血栓形成(PVT)的影响。方法:回顾性分析吉林大学中日联谊医院肝胆胰外科2012年1月至2016年11月收治的肝炎后肝硬化门静脉高压症50例,均行脾切除贲门周围血管离断术,以是否术后给予预防性抗凝治疗将其分为治疗组(26例)与对照组(24例)。治疗组术后24小时开始用低分子右旋糖酐500 ml加川芎嗪160 mg,持续7日,48小时后再加用低分子肝素钠5000 IU,持续7~14日。对照组给予常规治疗,不用预防性抗凝。两组患者术后第1、3、5、7、14日复查凝血项,每周1-2次彩超明确门脉系统血栓情况,出院后均有3~12个月随访。结果:治疗组血栓发生率11.5%(3/26),对照组血栓发生率37.5%(9/24)。结论:肝硬化门静脉高压症脾切除贲门周围血管离断术后预防性抗凝治疗能显著降低PVT发生率,术后早期进行抗凝治疗不会增加出血风险。治疗组术后发生PVT者行溶栓治疗效果较对照组更佳。
[Abstract]:Objective: to investigate the effect of preventive anticoagulation on portal vein thrombosis (PVT) after splenectomy in cirrhotic portal hypertension. Methods: a retrospective analysis was made on 50 cases of portal hypertension due to posthepatitic cirrhosis treated in the Department of Hepatobiliary and Pancreatic surgery, Sino-Japanese Friendship Hospital, Jilin University from January 2012 to November 2016. All patients were treated with splenectomy and pericardial devascularization. The patients were divided into treatment group (n = 26) and control group (n = 24). The treatment group was treated with low-molecular-weight dextran 500 ml plus ligustrazine 160 mg, for 7 days, followed by low-molecular-weight heparin sodium 5000 IU, for 7 ~ 14 days after 48 hours. The control group was given routine treatment without preventive anticoagulation. The thrombus of portal system was confirmed by color Doppler ultrasound 1-2 times a week. The patients in both groups were followed up for 3 ~ 12 months after discharge. Results: the incidence of thrombus was 11.5% (3 / 26) in the treatment group and 37.5% (9 / 24) in the control group. Conclusion: preventive anticoagulant therapy after splenectomy for cirrhotic portal hypertension can significantly reduce the incidence of PVT, and early anticoagulant therapy does not increase the risk of bleeding. The effect of thrombolytic therapy in patients with PVT after operation was better than that in control group.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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