前列地尔预防脾切除和断流术后门静脉系统血栓形成的历史对照研究  

Effects of alprostadil in the prevention of portal vein thrombosis after splenectomy and devascularization：a historical control study

作　　者：倪晓凌[1] 顾大镛[1] 胡国华[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中华肝胆外科杂志》2014年第5期351-354,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨应用前列地尔预防脾切除和断流术后门静脉系统血栓形成的疗效。方法以本院2009年5月至2013年4月术后预防性应用前列地尔的113例脾切除＋联合断流术患者作为治疗组，同时回顾2009年5月以前术后预防性应用传统药物的连续112例脾切除＋联合断流术患者作为对照组，比较两组患者并发症发生率、手术死亡率、术后腹腔引流量、血小板计数、凝血酶原时间以及肝功能Child—Pugh评分和门静脉系统血栓形成的发生率。结果和对照组相比，治疗组的并发症发生率和手术死亡率没有增加，腹腔引流量明显减少，血小板计数升高和凝血酶原时间延长相似，术后第3、7天肝功能损害程度也明显减轻。近期彩色多普勒超声随访显示，治疗组门静脉系统血栓发生率明显少于对照组，血栓的严重程度也减轻。结论前列地尔是一种安全、有效的预防术后门静脉系统血栓形成的药物，可以为脾切除＋断流术后全身抗凝提供一种新的选择。Objective To investigate the clinical outcomes of alprostadil in prevention of portal vein thrombosis after splenectomy and devascularization. Methods 113 patients with PHT who were treated with prophylactic alprostadil after splenectomy and devascularization procedures from May 2009 to Apr 2013 were included into the treatment group. 112 conservative patients with PI-IT who were treated with traditional prophylactic anticoagulants after the same operations before May 2009 were included as the control group. The postoperative complication rates, mortality, postoperative drainage volume from the abdominal cavity, blood platelet counts, prothrombin time, liver function, Child-Pugh＇s scores and portal vein thrombosis rates between the two groups were compared. Results When compared with the control group, the postoperative complication rate and mortality in the alprostadil group were not increased, while the postoperative drainage volume from the abdominal cavity was significantly reduced. The increase in blood platelet counts and prothrombin time were similar in the 2 groups. Furthermore, the extent of hepatic dysfunction on the 3rd and 7th after operation was significantly decreased. On short term follow-up, color droppler ultrasonography showed the portal vein thrombosis rate of the treatment group was significantly lower than the control group, with less extensive degree of thrombosis in the treatment group. Conclusion Alprostadil is a safe and effec- tive anticoagulant which provided better prevention of portal vein thrombosis after splenectomy combined with devascularization.

关 键 词：前列地尔 脾切除术 离断术 门脉高压 血栓 

分 类 号：R657.6[医药卫生—外科学]