肝切除术后静脉血栓栓塞症影响因素及预防的研究进展  

Venous thromboembolism prophylaxis after hepatectomy

作　　者：邬涛[1] 严律南[1] 罗艳丽[1] 

机构地区：[1]四川大学华西医院肝脏外科肝脏移植中心,成都610041

出　　处：《中国普外基础与临床杂志》2017年第7期895-899,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨肝切除术后静脉血栓栓塞症(venous thromboembolism,VTE)发生的影响因素及其预防的研究进展。方法复习国内外近几年肝切除术后VTE的相关报道。结果术后VTE发生的主要病因有:肿瘤、男性、老年、肝大部分切除术、术后高凝状态等。其中肝大部分切除术后患者VTE的发生率显著增高,这与术后肝功能不全引起血液高凝状态密切相关。VTE的预防主要包括机械性措施和抗凝血药物的应用,其中药物预防最为有效;而对于肝硬化、术后出血风险明显增高的患者,抗凝药物的使用需谨慎。同时对迟发性VTE高风险的患者,出院后延长药物抗凝治疗的时间十分必要。结论 VTE是肝切除术后常见的并发症,造成患者术后住院时间延长,术后死亡率增高。因此,明确术后发生VTE的相关风险对于改善肝切除术后患者的预后非常重要。Objective To investigate the risk factors and prevention methods of the venous thromboembolism （VTE） after hepatectomy. Methods The literatures about VTE after hepatectomy in recent years at home and abroad were reviewed and summarized. Results The risk factors for postoperative VTE include tumor, male, old age, massive hepatectomy, hypercoagulability, etc. The incidence of VTE in patients with massive hepatectomy is significantly higher, which is closely related to the hypercoagulability caused by postoperative liver dysfunction. Effective prophylaxis include mechanical methods and anticoagulant drugs, the latter of which can markedly reduce the incidence of VTE. For patients who develop postoperative liver insufficiency, including those with cirrhosis and high risk of bleeding, anticoagulant VTE prophylaxis dosing decisions should be made with caution. In addition, it is rationale for extended thromboprophylaxis in high risk patients. Conclusions VTE is a common complication after hepatectomy, resulting in prolonged postoperative hospital stay and increased postoperative mortality, Therefore, it is important to determine the risk of VTE after surgery to improve the prognosis of patients after hepatectomy.

关 键 词：肝切除术 静脉血栓栓塞症 预防 

分 类 号：R657.3[医药卫生—外科学]