早期抗凝、祛聚预防门静脉高压症脾切除术后门静脉血栓形成

Early anticoagulation therapy to prevent portal vein thrombosis after splenectomy

目的研究门静脉高压症病人脾切除术后早期接受抗血栓治疗对预防门静脉血栓形成的效果及安全性。方法将中山大学附属第三医院2003—2005年肝硬化门静脉高压症欲接受脾切除术的病人59例随机分为2组：早期使用抗凝、祛聚药物预防组与同期常规用药组为对照进行对比研究，利用彩色多普勒超声监测门静脉血栓形成情况。结果52例完成随访6个月以上，随访率88．1％，其中预防组29例，对照组23例。术后对照组10d内发生门静脉血栓1例，1个月内4例，1月后3例，合计8例（34．8％），1例为复发性血栓。预防组10d内无一例发生门静脉血栓，1个月内2例，1个月后1例，合计3例（10．3％），两组病例门静脉血栓发病率差异有显著性（X^2=4．59，P〈0．05），3例并发上消化道出血。结论门静脉高压症病人脾切除术后早期接受抗凝、祛聚治疗能降低术后门静脉血栓形成的发生率。

Objective To evaluate the efficacy and safety of early anticoagulation therapy in preventing portal vein thrombosis（PVT） in patients after splenectomy. Methods After splenectomy, 59 patients were randomized into two groups. Early anticoagulation therapy was compared with conventional treatment. Color Doppler ultrasonography was used for diagnosis. Results Fifty-two patients had finished investigation, including 29 cases with early anticoagulation therapy and 23 cases with conventional treatment. In conventional treatment group, 1 case developed PVT within 10 d, 4 cases within a month and 3 cases after a month, totally 8 cases （34.8%）. In early anticoagulation therapy group, none of the patients developed PVT within 10 d, 2 cases within a month, and 1 case after a month, totally 3 cases（ 10.3 %）. In contrast with conventional treatment group, PVT rate was significantly reduced in early anticoagulation therapy group （X^2 = 4.59, P〈0.05）. Three cases developed upper gastrointestinal hemorrhage. Conclusion Early anticoagulation therapy can reduce morbidity of PVT after splenectomy.