腹部肿瘤根治术后药物预防深静脉血栓  

Prevention and medical treatment of deep vein thrombosis in patients with abdominal tumors after the radical operation

作　　者：贺梁[1] 王江[1] 南林[1] 闫兵[1] 盖晓倩[1] 张永久[1] 

机构地区：[1]兰州军区乌鲁木齐总医院普通外科,830000

出　　处：《中华外科杂志》2011年第1期57-60,共4页Chinese Journal of Surgery

摘　　要：目的 总结腹部肿瘤规范化切除及淋巴结清扫术后深静脉血栓（DVT）预防的治疗经验及效果,探讨术后预防血栓的规范化治疗措施.方法 回顾分析2007年1月至2010年4月间548例接受腹部肿瘤规范化切除及淋巴结清扫病例术后应用低分子肝素、低分子右旋糖酐及丹参注射液防治血栓的临床资料,并按时间及用药方案将患者分为3组：第1组为2007年1月至2008年3月各类手术163例,术后当日起应用低分子右旋糖酐500 ml及丹参注射液0.2 g,持续7 d;第2组为2008年4月至2009年3月各类手术149例,术后当日起应用低分子右旋糖酐500 ml及丹参注射液0.2 g,低分子肝素40 mg,持续7 d;第3组为2009年4月至2010年4月各类手术236例,术后当日起应用低分子右旋糖酐500 ml,丹参注射液0.2 g,持续7 d,第3日起加用低分子肝素40 mg,持续7 d.比较分析三组治疗效果及伴随症状.结果 第1组术后64例（39.3%）D-二聚体检测呈阳性,15例（9.2%）下肢血管多普勒超声检查DVT呈阳性;第2组分别为38例（25.5%）和3例（2.0%）;第3组分别为62例（26.3%）和6例（2.5%）.总体看来,应用低分子肝素预防性抗凝治疗的第2、3组血栓发生率明显低于不应用低分子肝素的第1组,均应用低分子肝素而用药时间不同的第2、3组间血栓发生率无明显差异.通过临床观察发现,过早应用低分子肝素会导致相应伴随症状的出现.结论 术后当日起应用低分子右旋糖酐及丹参注射液静脉滴注,术后第3大起加用低分子肝素皮下注射对于预防腹部肿瘤根治术后DVT发生的效果较佳.Objective To summarize the prevention and treatment experience of deep vein thrombosis in patients with abdominal tumors after standardized resection and lymph node dissection, and to investigate a standard therapeutic measure of thrombosis prevention in these patients. Methods The clinical data of 548 patients who received radical operation and standardized lymph node dissection for abdominal tumors from January 2007 to April 2010 were analyzed retrospectively. According to different therapeutic scheme and time, the patients were divided into three groups： Group 1 included 163 cases from January 2007 to March 2008 were treated with compound Danshen injection 0. 2 g and low molecular weight dextran 500 ml on the same day of surgery for 7 days; Group 2 included 149 cases from April 2008 to March 2009 were treated with the same regimen as that in Group 1 plus low molecular heparin 40 mg on the same day of surgery for 7 days; Group 3 included 236 eases from April 2009 to April 2010 were treated with the same regimen as that in Group 1 plus low molecular heparin on the third day of surgery for 7 days. The treatment effects and the complications in the three groups were analyzed and compared. Results Sixty-four （39. 3% ） cases were D-Dimer positive and 15 （9. 2% ） cases were DVT positive under color Doppler ultrasound examination in Group 1; and those were 38 （25.5%） and 3 （2. 0% ） in Group 2; and 62 （26. 3% ） and 6（2. 5% ） in Group 3. Overall observation, the incidences of thrombosis in Group 2 and 3 were obviously lower than that of Group 1, but there was no significant difference between Group 2 and 3.Earlier use of low molecular heparin would lead to some complications. Conclusions It brings better effects in thrombosis prevention by using compound Danshen injection and low molecular weight dextran on the day of surgery, with low molecular heparin on the third day of surgery.

关 键 词：腹部肿瘤 静脉血栓形成 外科手术 

分 类 号：R735[医药卫生—肿瘤]