门静脉高压症脾切除术后的早期抗凝治疗  

Postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension

作　　者：王建新[1] 肖旭[1] 王卫兵[1] 陈骏[1] 蔡邢峰[1] 

机构地区：[1]江苏省南通市第三人民医院肝胆外科,226000

出　　处：《中国医师进修杂志》2013年第32期5-7,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 研究脾切除术后早期接受抗凝治疗对预防门静脉血栓形成的效果.方法 对行脾切除＋贲门周围血管离断术的140例患者按随机数字表法分为抗凝组（76例）和对照组（64例）,抗凝组术后早期根据血小板计数予以川芎嗪、阿司匹林、低分子量肝素等药物进行早期抗凝治疗;对照组术后早期不进行抗凝治疗,术后监测血小板计数及D-二聚体,B超或CT检查是否存在门静脉血栓.结果 抗凝组和对照组在脾切除术后第2天血小板计数、D-二聚体水平均显著上升,与术前比较差异有统计学意义[抗凝组：（95.73±28.06）×109/L比（38.41±11.96）×109/L、（3.61±0.18） mg/L比（0.42±0.09） mg/L,对照组：（92.56±27.25）×109/L比（35.13±11.38）×109/L、（3.26±0.16） mg/L比（0.37±0.09） mg/L,P＜ 0.05].术前及术后第2天两组血小板计数、D-二聚体水平比较差异均无统计学意义（P＞0.05）.术后对照组发生门静脉血栓10例,抗凝组发生门静脉血栓3例,抗凝组门静脉血栓发生率[3.95％（3/76）]与对照组[15.62％（10/64）]比较差异有统计学意义（P＜0.05）.结论 门静脉高压症脾切除术后早期抗凝治疗是预防门静脉血栓形成的有效方法.Objective To study the effect of postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension.Methods One hundred and forty patients with cirrhosis and portal hypertension receiving splenectomy and periesophagastric devascularization were divided into anticoagulant group （76 cases） and control group （64 cases） by random number table,patients in anticoagulant group received postoperative anticoagulant therapy,principally according to the platelet count,gave ligustrazine,aspirin,low molecular heparin after operation; patients in control group without postoperative anticoagulant therapy.Postoperative monitoring platelet count and D-dimer,ultrasound or CT check the presence of portal vein thrombosis.Results Platelet count,D-dimer levels in anticoagulant group and control group in 2 days after operation were significantly increased,the difference was significant compared with preoperative [anticoagulant group：（95.73 ± 28.06） × 109/L vs.（38.41 ± 11.96） × 109/L,（3.61 ± 0.18） mg/L vs.（0.42 ± 0.09） mg/L;control group：（92.56 ± 27.75） × 109/L vs.（35.13 ± 11.38） × 109/L,（3.26 ± 0.16） mg/L vs.（0.37 ± 0.09） mg/L,P 〈 0.05].Platelet count and D-dimer levels between two groups at preoperative and postoperative in 2 days had no statistical significance （P 〉 0.05）.Ten cases of control group occurred postoperative portal vein thrombosis,anticoagulant group were 3 cases,portal vein thrombosis incidence of anticoagulant group [3.95% （3/76）] compared with control group [15.62%（10/64）] was statistically significant （P 〈 0.05）.Conclusion Postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension is an effective method to prevent portal vein thrombosis.

关 键 词：脾切除术 门静脉 血栓形成 抗凝药 

分 类 号：R657.6[医药卫生—外科学]