早期使用抗凝、袪聚药物对门静脉高压症术后门静脉血栓形成的预防作用

Precautionary effect on the early application of anticoagulant drugs to portal vein thrombosis in patients with portal hypertension after operation.

目的:对门静脉高压症术后门静脉血栓形成(portal vein thrombosis,PVT)的预防性治疗进行回顾性对比研究,探讨术后预防性抗凝、祛聚治疗的最佳时机。方法:2006年3月～2011年3月我院收治的肝硬化门静脉高压症并手术治疗病例320例,纳入研究者120例。根据低分子肝素等抗凝药及潘生丁、低分子右旋糖酐、川芎嗪等祛聚药的应用情况将120例分为三组,其中,A组60例,术后未用抗凝、祛聚药;B组35例,在血小板>300×109/L时行祛聚治疗,在血小板>500×109/L时,加用抗凝药物治疗;C组25例,早期(术后3～5 d)行祛聚治疗,在血小板>300×109/L时,加抗凝药物治疗。统计各组的PVT发生率及腹腔出血、消化道出血等并发症的发生率。结果:术后2周内A组、B组和C组发生PVT的例数分别为26例、12例和2例,发生率分别为43.3%、34.3%和8.0%。A组和B组的门静脉血栓形成发生率无统计学差异(χ2=0.003,P=0.960),C组的门静脉血栓形成发生率明显低于A组(χ2=5.082,P=0.024)和B组(χ2=4.856,P=0.028)。术后3组病例引流管平均放置时间、引流液总量、术后第7天凝血酶原延长时间比较差异无统计学意义(P>0.05)。结论:术后早期应用抗凝、祛聚药物能有效预防门静脉血栓形成。

Objective： To study the precautionary effect of portal vein thrombosis in patients with portal hypertension after operation,and find a better way to prevent the portal vein thrombosis.Methods： 120 patients were selected from 320 cases with portal hypertension after operation in our hospital from March 2006 to March 2011.All the patients were divided into three groups through the application of anticoagulant drugs such as LMWH and drugs such as Dipyridamole,low molecular dextran and Ligustrazine.There were 60 patients in group A without anticoagulation therapy after operation;there were 35 patients in group B with anticoagulation therapy after operation when platelet was exceeded 300×109/L;there were 25 patients in group C with anticoagulation therapy after operation in the earlier time.The incidence rate of the portal thrombosis was compared among three groups.Results： All the patients received color Dopplar examination within 2 weeks after operation.The number of portal vein thrombosis occured was 26 patients（43.3%） in group A,12 patients（34.3%） in group B and 2 patients（8%） in group C.The difference of the incidence rate of the portal system thrombosis among three groups was not significant between group A and B（χ2=0.003,P=0.960） and was significant between group A and C（χ2=5.08,P=0.024） also between group B and C（χ2=4.856,P=0.028）.The duration of catheter drainage,drainage amount and prothrombin time in 7th day after operation were no significant different among the three groups.Conclusion： The application of anticoagulation therapy in the earlier period can prevent the formation of the portal vein thrombosis in patients with portal hypertension after operation.