抗凝治疗在肝硬化患者脾切除术后减少PVT的疗效及安全性研究  

Efficacy and safety of anticoagulation therapy for PVT after splenectomy in patients with liver cirrhosis

作　　者：甄勇[1] 王兵济 杜华劲[1] 高学健[1] 王仔平[1] 宣佶 张尊庶 王传泰 耿家宝 ZHEN Yong;WANG Bing-ji;DU Hua-jin;GAO Xue-jian;WANG Zi-ping;XUAN Ji;ZHANG Zun-shu;WANG Chuan-tai;GENG Jia-bao(Department of General Surgery,Chuzhou First People's Hospital,Anhui 239000,China;Department of General Surgery,Eastern Theater General Hospital QinHtiai District Medical Area,Nanjing 210002,China;Department of Endoscopy center,Eastern Theater General Hospital QinHuai District Medical Area,Nanjing 210002,China;Department of Infectious Diseases,Eastern Theater General Hospital Qinhuai District Medical Area,Nanjing 210002,China)

机构地区：[1]滁州市第一人民医院普外科,安徽239000 [2]东部战区总医院秦淮医疗区肝胆外科 [3]东部战区总医院秦淮医疗区胃镜中心 [4]东部战区总医院秦淮医疗区感染科/肝病中心

出　　处：《肝脏》2022年第2期169-173,共5页Chinese Hepatology

基　　金：国家自然科学青年基金(81704196)。

摘　　要：目的 探讨抗凝治疗在肝硬化患者行脾脏切除术后,减少门静脉系统血栓(PVT)发生风险的疗效及安全性。方法 选择2015年12月至2020年6月在滁州市第一人民医、东部战区总医院秦淮医疗区住院行脾脏切除术的肝硬化患者106例,对照组50例,试验组56例。试验组患者术后24 h,给予低分子量肝素(皮下注射,1次/日,1周)联合华法林(口服,24周)抗凝治疗。对照组未予抗凝治疗。比较两组患者术后PVT发生率、肝功指标、Child-Pugh评分、门静脉直径、门静脉血流速度、并发症发生率、平均住院时间等。结果 抗凝组、对照组术后PVT发生率分别为2周16.1%和44%,4周12.5%和40%,12周8.9%和38.0%,24周7.1%和34.0%,48周7.1%和32.0%。术后2周、4周、12周、24周、48周抗凝组的TBil、DBil、ALT、Child-Pugh评分均低于对照组,P<0.05。术后2周、4周、12周、24周、48周抗凝组的门静脉平均直径小于对照组,血流速度高于对照组,P<0.05。术后48周试验组、对照组并发症的发生率分别为:消化道出血3.6%、10.0%,肝性脑病1.8%、8.0%,肠坏死1.8%、6.0%,P>0.05;腹水14.3%、32.0%,P<0.05。抗凝组平均住院时间(10.8±2.9)d,小于对照组[(15.9±4.6)d],P<0.05。抗凝治疗期间,未见明显不良反应。结论 抗凝治疗可有效减少肝硬化患者脾切术后PVT的发生风险,安全性良好。Objective To investigate the efficacy and safety of anticoagulation therapy for portal vein thrombosis(PVT)after splenectomy in cirrhosis patients.Methods A total of 106 cirrhosis patients admitted to our hospital from December 2015 to June 2019 who underwent splenectomy were enrolled.They were randomly divided into control group(50cases)and experimental group(56 cases).Patients in experimental group were treated with low molecular heparin(subcutaneous injection,once a day for a week)combined with warfarin(oral administration,24 weeks)24 hours after splenectomy,while the control group received no anticoagulation therapy after splenectomy.The rate of PVT,liver function index,Child-Pugh score,diameter of portal vein(Dpv),velocity of portal vein(Vpv),complication rates and average hospitalization time of 2 groups were compared.Results The rates of PVT in experimental group and control group were16.1% and 44%in 2 weeks after splenectomy,12.5% and 40.0%in 4 weeks after splenectomy,8.9% and 38.0%in 12weeks after splenectomy,7.1% and 34.0% in 24 weeks after splenectomy,7.1% and 32.0% in 48 weeks after splenectomy,respectively.The levels of total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT)and Child-Pugh score of experimental group in week2,4,12,24 and48 after splenectomy were significantly lower than those of control group(P<0.05),respectively.The Dpv of experimental group was wider than that of control group,and the Vpv of experimental group was faster than that of control group in week 2,4,12,24 and 48,P<0.05.At week 48,the rates of alimentary tract hemorrhage of experimental group and control group were 3.6% and 10.0%(P>0.05),the rates of hepatic encephalopathy of the 2 groups were1.8% and 8.0%(P>0.05),the rates of intestinal necrosis of the 2 groups were 1.8% and 6.0%(P>0.05),the rates of ascites of the 2 groups were 14.3% and 32.0%(P<0.05).The average hospitalization time of experimental group(10.8±2.9 days)was significantly shorter than that of control group(15.9±4.6 days),P<0.05.No obvio

关 键 词：肝硬化 脾切除 抗凝治疗 门静脉系统血栓 安全性 

分 类 号：R657.6[医药卫生—外科学]