华法林防治改良腹腔镜脾切除联合贲门周围血管断流术后门静脉血栓的临床疗效  

Clinical efficacy of warfarin in preventing portal vein thrombosis after modified laparoscopic splenectomycombined with pericardial devascularization

作　　者：蒋国庆 柏斗胜 钱建军 陈平 姚捷 金圣杰 杨逵生 

机构地区：[1]扬州大学临床医学院肝胆外科,225001

出　　处：《中华消化外科杂志》2016年第1期71-74,共4页Chinese Journal of Digestive Surgery

基　　金：江苏省卫生厅面上科研课题（H201452）

摘　　要：目的探讨采用华法林防治改良腹腔镜脾切除联合贲门周围血管断流术后门静脉系统血栓形成的近期疗效。方法采用回顾性队列研究方法。收集2014年1-8月扬州大学临床医学院收治的32例肝硬化性门静脉高压症患者的临床资料。术前向患者介绍术后华法林和阿司匹林用药方案的特点，由患者术前自行选择术后用药方案。术后采用华法林进行治疗的患者设为华法林组（17例）；采用阿司匹林治疗的患者设为阿司匹林组（15例）。手术方式采用改良腹腔镜脾切除联合贲门周围血管断流术，术中使用自体血回输技术。华法林组的用药方案：术后第3天起，每日口服华法林2．5mg，并调整华法林的用量，尽可能将国际标准化比值（INR）调整为2．0-3．0，服用1年；术后第3天起，每日口服双嘧达莫50mg3次，服用3个月；术后第3天起，每日皮下注射低分子肝素钙4100U，共5d。阿司匹林组用药方案：术后第3天起，每日口服阿司匹林100mg，服用1年；其他治疗同华法林组。所有患者术后1个月及术后3个月行血细胞分析、肝功能、凝血功能及门静脉系统血管彩色多普勒超声检查；术后3个月行胃镜检查了解食管胃底静脉曲张程度的变化情况，随访时间截至2015年2月。观察患者术后1周、1个月、3个月的血栓发生率，术前和术后1周、1个月、3个月的INR。正态分布的计量资料以孟±S表示，采用t检验；偏态分布的计量资料以M（范围）表示，采用秩和检验。两组间不同时间点的INR均数比较采用重复测量的方差分析；计数资料比较采用Fisher确切概率法。结果两组患者术后无消化道出血症状和围术期死亡。（1）华法林组与阿司匹林组患者术后第1周门静脉系统血栓总发生率为9／17，阿司匹林组为6／15，两组比较，差异无统计学意义（P〉0．05）。华法林组患者术后第1个月和术�Objective To investigate the short-term therapeutic effect of warfarin in preventing portal vein thrombosis （PVT） after modified laparoseopic spleneetomy combined with pericardial devascularization. Methods The retrospective cohort study was used to analyze the clinical data of 32 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2014 and August 2014. The characteristics of warfarin and aspirin regimens were introduced to the patients before operation for choosing postoperative therapeutic regimen. Based on the decisions, 17 and 15 patients receiving warfarin regimen and aspirin regimen were divided into the warfarin group and the aspirin group, respectively. All the patients underwent successful modified laparoscopic splenectomy and pericardial devascularization with intraoperative autologous blood salvage. The treatments were as follows ： from postoperative day 3, patients in the warfarin group received 2.5 mg of oral warfarin once daily with titration of the dose to maintain a target international normalized ratio （INR） of 2.0-3.0 for 1 year; patients in the aspirin group received 100 mg aspirin enteric coated tablets for 1 year; and both groups received 50 mg of oral dipyridamole three times daily for 3 months and subcutaneous injection of 4 100 U of low-molecular-weight heparin （LMWH） once daily for 5 days. Blood cell analysis, liver function, coagulation function and Doppler ultrasound screening for the occurrence of PVT were performed at the first and third months. Postoperative electronic gastroscopy was performed at 3 months postoperatively for observing the change of the esophageal and gastric-fundus varices. The patients were followed up till February 2015. The incidences of PVT and the level of INR at the first week, the first month and the third month after operation were observed. Measurement data with normal distribution were presented as x ± s and analyzed by t test, and measurement data with skewed d

关 键 词：门静脉高压症 静脉血栓 华法林 脾切除术 贲门周围血管离断术 腹腔镜检查 

分 类 号：R657.3[医药卫生—外科学]