肝硬化门静脉高压症分流加断流术后门静脉内抗凝预防血栓形成  

Postoperative intraportal vein antieoagulation in the prevention of portal vein thrombosis in portal hypertensive patients

作　　者：王李华 陆炜 申桂娟 余耀生 诸葛勇华 胡雅国 吴显清 徐天生 

机构地区：[1]浙江省衢州市中心医院血管外科,324000

出　　处：《中华普通外科杂志》2007年第12期912-914,共3页Chinese Journal of General Surgery

摘　　要：目的探讨抗凝在门静脉高压症分流加断流术中应用的临床意义。方法将67例门静脉高压症患者分为2组，均行分流加断流联合手术。A组（32例）在术后行抗凝治疗，B组（35例）术后未行抗凝治疗。比较两组之间门静脉系统血栓形成、远期上消化道再出血发生率及手术前后门静脉高压性胃病的改善情况。结果A组术后门静脉系统血栓发生率（0）明显低于B组（20％），两组之间相比差异有统计学意义，x^2=5．169，P〈0．05。B组远期上消化道再出血发生率（30％）明显高于A组（7％），两组之间相比差异有统计学意义，x^2=4．923，P〈0．05。A组门静脉高压性胃病得到明显缓解。结论抗凝治疗可明显降低断流加分流手术后门静脉系统血栓形成、远期上消化道再出血的发生率，是一种安全有效的治疗措施。Objective To investigate the clinical significance of intraportal vein anticoagulation for the prevention of portal vein thrombosis after portaazygous devascularization and splenorenal shunt. Methods In this study 67 patients of portal hypertension undergoing surgery were randomly divided into two groups, receiving respectively intraportal vein heparin injection by 100 U · kg^-1· d ^-1× 7 d in group A （32 patients） and placebo in group B （35 patients）. Portal vein thrombosis, the recurrent bleeding after operation and portal hypertensive gastropathy were compared between the two groups. Results The occurrence of portal vein thrombosis after operation in group A （0） was significantly lower than that in group B （20%, x^2 = 5. 169,P 〈 0.05）. The rate of long-period recurrent bleeding in group B （30%） was significantly higher than that in group A （7%）, x^2 = 4. 923, P 〈 0. 05. Portal hypertensive gastropathy was ameliorated significantly in group A. Conclusion Anticoagulation therapy reduces the risk of portal vein thrombosis and the long term recurrent bleeding in portal hypertensive patients after portaazygous devascularization and splenorenal shunt.

关 键 词：高血压 门静脉 血栓形成 抗凝药 脾肾分流术 外科 

分 类 号：R657.34[医药卫生—外科学] R654.2[医药卫生—临床医学]