早期使用低分子肝素预防门静脉高压断流术后门静脉血栓形成  

Early use of low-molecular heparin to prevent portal thrombosis after splenectomy and pericardial devascularization in patients with portal hypertension

作　　者：匡洁[1] 杨卫平[1] 陈皓[1] 彭承宏[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《外科理论与实践》2015年第2期131-134,共4页Journal of Surgery Concepts & Practice

基　　金：卫生部行业科研专项项目(201002015)

摘　　要：目的 :探讨脾切除加贲门周围血管离断术后早期使用低分子肝素的抗凝治疗对预防门静脉血栓形成的疗效及安全性。方法:2011年1月至2013年6月因肝硬化门静脉高压在我院行脾切除加贲门周围血管离断术的病人106例,其中抗凝组(41例)和非抗凝组(65例),抗凝组在术后第1天开始使用依诺肝素钠1支,连续2周。结果:比较性别、年龄、病因、Child-Pugh分级、手术前后血小板计数、术前D-二聚体以及门静脉直径、流量和流速,切脾前及贲门周围血管离断术后自由门静脉压力及压力差,这些因素在抗凝组和非抗凝组之间的差异无统计学意义(P>0.05)。抗凝组术后门静脉血栓形成率显著低于非抗凝组(17.1%比43.1%,P=0.006)。形成血栓病人的血小板计数高于未形成者(608.9×109/L比302.4×109/L,P<0.001)。抗凝组使用低分子肝素期间未发生创面渗血和上消化道出血。结论:脾切除加贲门周围血管离断术后早期使用低分子肝素的抗凝治疗安全有效,可减少门静脉血栓的发生。Objective To investigate the effect and safety of early use of low-molecular heparin for the prevention of portal thrombosis after splenectomy and pericardial devascularization. Methods One hundred and six patients with portal hypertension experienced splenectomy and pericardial devascularization were analyzed between January 2011 and June2013. These patients were divided into heparin group（n=41） and non-heparin group（n=65）. In the heparin group, one dose of enoxaparin was used two weeks since the first day after operation. Results The parameters including sex, age,cause, Child-Pugh classification, perioperative platelet count, preoperative indexes of D-dimer, portal vein diameter and flow and velocity, free portal pressure before and after splenectomy with devascularization had no significant difference between two groups（P〉0.05）. The rate of portal vein thrombosis in heparin group was lower significantly comparing with that in non-heparin group（17.1% vs 43.1%, P=0.006）. The platelet count of the patients with portal thrombosis was more than that of the patients without portal thrombosis significantly（608.9 ×10^9/L vs 302.4×10^9/L, P〈0.001）. There was no incision hemorrhage and upper gastrointestinal bleeding in heparin group. Conclusions Early use of low-molecular heparin could reduce the incidence of portal vein thrombosis significantly without safe problem for the patients with splenectomy and pericardial devascularization.

关 键 词：低分子肝素 门静脉血栓 门静脉高压 脾切除 贲门周围血管离断 

分 类 号：R657.34[医药卫生—外科学]