胰肾联合移植术后抗凝治疗方案的回顾性队列研究  

Clinical application of anticoagulation therapy after simultaneous pancreas and kidney transplantation: a single-center observational cohort study

作　　者：刘路浩[1] 方佳丽[1] 李光辉[1] 张磊[1] 徐璐[1] 熊韫祎 尹威[1] 吴佳林[1] 陈荣鑫[1] 郭予和 马俊杰[1] 陈正[1] Liu Luhao;Fang Jiali;Li Guanghui;Zhang Lei;Xu Lu;Xiong Yunyi;Yin Wei;Wu Jialin;Chen Rongxin;Guo Yuhe;Ma Junjie;Chen Zheng(Department of Organ Transplantation,the Second Affiliated Hospital of Guangzhou Medical University,Guangdong Province,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院器官移植科,510260

出　　处：《中华器官移植杂志》2021年第11期663-668,共6页Chinese Journal of Organ Transplantation

基　　金：广东省医学科研基金项目(A2021384)。

摘　　要：目的比较胰肾联合移植术后应用阿司匹林和肝素抗凝的临床效果。方法选择2016年9月至2020年3月在广州医科大学附属第二医院器官移植科行胰肾联合移植手术的受者, 根据术后抗凝方案不同将受者分为阿司匹林组和肝素组。阿司匹林组的受者从术后第1天开始接受100 mg阿司匹林。肝素组的受者术后第1天开始皮下注射依诺肝素2 000 AxaIU, 共持续7 d, 1周后序贯改为口服阿司匹林100 mg/d和氯吡格雷75 mg/d抗凝。比较两组移植后临床效果和并发症的发生率。结果本研究共纳入129例在接受胰肾联合手术的受者, 其中阿司匹林组受者60例, 肝素组为69例。两组受者均成功接受手术, 无一例死亡, 阿司匹林组出现了5例胰腺血栓, 其中胰腺切除1例, 肝素组未出现胰腺血栓, 两组差异有统计学意义(P=0.014);阿司匹林组发生了8例肠道吻合口出血, 而肝素共出现了19例, 两组差异有统计学意义(P=0.048)。两组在移植物功能延迟, 排斥反应等方面差异无统计学意义。结论胰肾联合移植术后应用肝素抗凝可以显著降低术后胰腺血栓的发生率, 虽然肠道吻合口出血的发生率有所增加, 但经保守治疗后均未出现严重并发症。Objective To explore the clinical efficacy of aspirin plus low molecule heparin for pancreatic thrombosis during simultaneous pancreas and kidney transplantation(SPK).Methods A total of 129 patients aged 18 years or higher underwent SPK between September 2016 and March 2020.They were divided retrospectively into two groups of aspirin(n=60)and heparin(n=69)according to different anticoagulant regimens.The aspirin group received only aspirin 100 mg/d at Day 1 post-operation.The heparin group received subcutaneous injection of enoxaparin 2000 AxaIU daily for 7 days and followed by aspirin and clopidogrel.Outcomes and complication rates were compared between two groups.Results All operations were successful without any mortality.In aspirin group,there were 5 cases of pancreatic thrombosis and one patient underwent pancreatectomy.There was no pancreatic thrombosis in heparin group(P=0.014).There were 8 cases of intestinal anastomotic bleeding in aspirin group and 19 cases in heparin group.Statistically significant inter-group difference existed(P=0.048).However,no significant inter-group difference existed in delayed recovery or rejection.Conclusions Heparin anticoagulation can significantly lower the incidence of pancreatic thrombosis after SPK.Despite a higher incidence of intestinal anastomotic bleeding,no serious complication occurs after conservative meaures.

关 键 词：胰腺移植 肾移植 血栓形成 肝素 

分 类 号：R699.2[医药卫生—泌尿科学] R657.5[医药卫生—外科学]