脾切除断流术后早期抗凝预防门静脉系统血栓形成

Early anticoagulation after splenectomy in the prevention of portal vein thrombosis in cirrhotics

目的探讨门静脉高压症脾亢患者脾切除＋断流术后早期抗凝治疗预防门静脉系统血栓形成（portal vein thrombogenesis，PVT）的效果。方法总结河北省沧州中心医院1994年8月至2011年7月157例患者行脾切除＋断流手术，其中2000年以后手术的89例术后24h开始用低分子右旋糖苷500ml＋川芎嗪160mg，每日1次静点，持续1周，48h后再加用低分子肝素钙4250U每12小时1次皮下注射，持续7—14d为预防组；以2000年以前68例术后未预防性用药为对照组。通过3～12个月随访，分析两组PVT的发生情况。结果预防组血栓发生率为8％（7／89），其中Ⅰ、Ⅱ级血栓占5／7，Ⅲ级以上血栓占2／7，无肠坏死病例；对照组血栓发生率为29％（20／68），其中Ⅰ、Ⅱ级血栓占20％（4／20），Ⅲ级以上血栓占80％（16／20），有3例出现肠坏死，两组PVT发生率之间比较差异有统计学意义，x2=12．57，P=0．00；两组Ⅲ级以上血栓分级相比差异有统计学意义，0=17．20，P=0．00。预防组在预防用药期间未发生明显出血并发症。结论PVT形成是多种原因促成的结果，术后早期进行抗凝治疗不仅安全，而且疗效满意。

Objective To evaluate the effect of early anticoagnlation therapy in the prevention of portal venous system thrombosis （PVT） in portal hypertensive patients undergoing splenectomy plus portaazygous devascularization. Methods At our hospital from August 1994 to July 2011, 157 patients underwent splenectomy plus devascularization. Among them 89 cases （beginning 2000 ） receiving intravenous low molecular dextran 500 ml daily for 7 clays starting immediately postoperatively, and after 48 h subcutaneously low molecular weight heparin calcium 4250 U every 12 hours for 7 - 14 d were in group A. Before 2000, the 68 cases receiving no postoperative anticoagulation therapy were in the control group （B）. After 3 - 12 months follow-up, PVT was evaluated and compared between the two groups. Results In group A thrombosis incidence was 8% （7/89）, of which class I , II thrombosis accounted for 71% （5/7） , class m and up thrombosis accounted for 29% （2/7）, there was no bowel necrosis case; In group B thrombosis incidence was 29% （20/68） , class I ,II thrombosis accounted for 20% （4/20） , class III and above thrombosis accounted for 80% （16/20） , 3 cases suffered from intestinal necrosis, the difference was statistically significant （P 〈 0. 01 ）. Conclusions Muhifactors lead to postoperative PVT formation, early postoperative, anticoagulation therapy is safe, and effective in the prevention of postoperative PVT.