不同时间窗抗凝对腹腔镜脾切除联合贲门周围血管离断术后患者门静脉血栓形成的预防作用  

Preventive anticoagulant therapy at different time windows for portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization

作　　者：谢飞[1] 王杰 牟廷刚[1] 钟平勇 彭利[1] Xie Fei;Wang Jie;Mou Tingang;Zhong Pingyong;Peng Li(The First Department of General Surgery,The First People’s Hospital of Neijiang,Neijiang 641000,Sichuan Province,China)

机构地区：[1]内江市第一人民医院普外一科,四川省内江市641000

出　　处：《中华肝胆外科杂志》2019年第6期435-438,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨不同时间窗预防性抗凝治疗对腹腔镜脾切除联合贲门周围血管离断术后患者门静脉血栓形成的预防作用与安全性。方法通过随机、单盲对照法,将内江市第一人民医院2017年3月至2018年12月收治的83例因慢性乙肝肝硬化门静脉高压并脾亢住院行腹腔镜脾切除联合贲门周围血管离断术的患者分为术后非预防性抗凝治疗组(阴性对照组,21例),术中预防性抗凝治疗组(术中抗凝组,23例),术后24小时预防性抗凝治疗组(24小时抗凝组,19例),术后48小时预防性抗凝治疗组(48小时抗凝组,20例),分别观察四组患者术后门静脉血栓发生率及严重等级。术后复查血小板计数、PT、D-二聚体的变化情况。结果阴性对照组、术中抗凝组、24小时抗凝组、48小时抗凝组患者的门静脉血栓发生率分别为100%、39.1%、47.3%、55%,4组间差异有统计学意义(P<0.05)。其中术中抗凝组与术后24小时抗凝组门静脉血栓发生率差异无统计学意义(P>0.05),术后48小时抗凝组门静脉血栓发生率高于术中抗凝组和术后24小时抗凝组(P<0.05),术后出血并发症发生率各组差异无统计学意义(P>0.05)。各组术后血小板计数差异无统计学意义(P>0.05);非抗凝组术后血清D-2聚体水平及PT延长时间明显高于预防性抗凝治疗组(均P<0.05)。结论预防性抗凝治疗能有效的降低腹腔镜脾切除联合贲门周围血管离断术后门静脉血栓形成的发生率,且不增加术后出血并发症风险。Objective To investigate the efficacy and safety of preventive anticoagulant therapy at different time windows on formation of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization. Methods The study was performed as a randomized, prospective trial. 83 patients with portal hypertension who underwent laparoscopic splenectomy and pericardial devascularization were divided into four groups: the non preventive anticoagulant group (n=21), the prophylactic anticoagulant group (n=23), the 24 hours of preventive anticoagulant group (n=19) and the 48 hours of preventive anticoagulant group (n=20). The incidences of postoperative portal vein thrombosis, the Yerdel grading, platelet count, APTT, and bleeding complications were studied. Results The incidences of portal vein thrombosis in the four groups were 100%, 39.1%, 47.3%, 55%, respectively, and the difference among the 4 groups was significantly different (P<0.05). The incidences of portal vein thrombosis between the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group showed no significant difference (P>0.05), but the incidences of portal vein thrombosis after 48 hours of preventive anticoagulant group was significantly higher than the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group, respectively (P<0.05). Postoperative bleeding complications, platelet count and APTT after the operations showed no significant differences (P>0.05). However, the plasma level of D-dimer in the non preventive anticoagulant group was significantly higher than the preventive anticoagulant group (P<0.05). Conclusion Preventive anticoagulant therapy effectively reduced the incidence of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization, but it did not significantly increase the risk of postoperative bleeding complications.

关 键 词：腹腔镜 脾切除术 贲门周围血管离断术 抗凝治疗 时间窗 门静脉血栓 

分 类 号：R657.3[医药卫生—外科学]