断流术后门静脉血栓形成的相关因素分析及早期活血、抗凝、袪聚治疗的疗效研究

Related factors of portal vein thrombosis after undergoing devascularization and the effects of early anticoagulation,promoting blood circulation,removing poly treatment

目的:研究断流术后门静脉血栓形成的相关因素及早期活血、抗凝、袪聚治疗的疗效。方法:选取在本院接受断流术的226例患者,给予早期活血、抗凝、袪聚治疗并进行前瞻性研究;选取同在本院接受断流术的100例患者,术后常规预防性应用止血药物及并进行回顾性研究。根据术后3个月内血栓形成情况将入选者分为血栓组和非血栓组,调查断流术后门静脉血栓形成的相关因素,并比较早期活血、抗凝、袪聚治疗前后门静脉血栓形成的发生率。结果:血栓组的脾脏质量、术后红细胞计数、术后1、7d血小板计数及二聚体水平高于非血栓组,术后门静脉内径大于非血栓组,术后门静脉血流速度低于非血栓组,差异有统计学意义(P<0.05);logistic回归分析显示脾脏质量大、术后红细胞计数偏高、术后1、7d血小板计数及二聚体含量偏高、门静脉内径偏窄、血流速度偏慢是门静脉血栓形成的危险因素;早期活血、抗凝、袪聚治疗患者的血栓发生率低于预防性应用止血药物的患者,差异有统计学意义(P<0.05)。结论:血小板和二聚体含量升高、门静脉血流动力学异常是断流术后门静脉血栓形成的危险因素,术后早期进行活血、抗凝、袪聚治疗有助于预防门静脉血栓的形成。

Objective.. To analyze related factors of portal vein thrombosis after undergoing devascularization and the effect of early anticoagulation, promoting blood circulation, removing poly treatment. Methods： A total of 226 patients received devascularization in our hospital were enrolled, given early anticoagulation, promoting blood circulation, removing poly treatment and all eases were prospectively studied; 100 cases of patients received devascularization in our hospital were also enrolled and given hemostatic drug, they were retrospectively studied. Enrolled patients were divided into thrombus group and nonthrombus group according to occurrence of thrombosis 3 months after undergoing operation. Then portal vein thrombosis related factors were investigated, incidence of portal vein thrombosis before and after anticoagulation, promoting blood circulation, removing poly treatment were compared. Results： （1）Spleen weight, postoperative red cell count, 1 d and 7 d postoperative platelet count, 1 d and 7 d postoperative diameter of thrombus group were higher and larger than those of non-thrombus group~ portal vein blood velocity was slower than those of non- thrombus group; （2） Logistic regression analysis showed that spleen mass weight, postoperative red cell count, platelet count and diameter content, narrow portal vein diameter, slow blood flow speed were risk factors of portal vein thrombosis formation; （3） early anticoagulation, promoting blood circulation, removing poly treatment is helpful to reduce the incidence of thrombosis. Conclusion： High level of platelet count and dimer content, portal vein hemodynamic abnormalities are risk factors of postoperative portal vein thrombosis; early anticoagulation, promoting blood circulation, removing poly treatment can effectively prevent the formation of portal vein thrombosis.