低分子肝素在预防D-二聚体异常升高的胆道结石合并感染患者术后门静脉血栓形成中的临床研究

Clinical research on the effect of Low-molecular-weight heparin( LMWH) in preventing abnormal elevated D-Dimer induced portal vein thrombosis after surgery of patients suffering from biliary stones and biliary tract infection

目的探讨低分子肝素(Low molecular weight heparin,LMWH)在预防D-二聚体(DDimer,D-D)异常升高的胆道结石合并感染患者术后门静脉血栓形成(portal vein thrombosis,PVT)中的应用。方法选择2010年1月至2014月8月于我院普外科进行诊治的D-D异常升高的胆道结石合并感染患者共116例。所有病例均住院行腹腔镜联合胆道镜手术治疗,术前检查D-D均异常升高。按病人意愿同意或不同意LMWH治疗分组。同意进行LMWH治疗的85例患者分成2组。A组42例:手术前3天即开始接受LMWH治疗,手术后继续接受LMWH治疗+静脉抗炎+导管引流治疗组;B组43例:手术后第3天才开始接受LMWH治疗+静脉抗炎+导管引流治疗组。将不同意LMWH治疗的31例患者设为对照组C组,仅接受传统的手术+静脉抗炎+导管引流治疗。比较3组患者术前以及术后第7、14、30天血浆D-D水平和术后第30天出现PVT人数的比较。结果术后第7天复查血浆D-D水平,A、B两组均低于C组,A、C两组比较差异有高度统计学意义(P<0.01),B、C两组比较差异有统计学意义(P<0.05)。术后第14以及30天复查血浆D-D水平,A、B两组均明显低于C组(P<0.01)。使用LMWH组(A+B组)出现PVT的比率明显低于不使用组(C组)(P<0.01)。结论 LMWH用于治疗D-D异常升高的胆道结石合并感染患者,能明显降低血浆D-D水平以及术后PVT的发生率。建议在查出血浆D-D异常升高时即可及早使用。

Objective Explore the application of LMWH in preventing postoperative complication PVT caused by abnormal elevated D- Dimer（ D- D） of patients suffering from biliary stones and infection. Methods Chose 116 patients diagnosed and treated in department of General Surgery of our hospital during January 2010 and August 2014. All patients were hospitalized for laparoscopic surgery combined choledochoscope surgery,and their D- D values were abnormally elevated before surgery. According to the patients whether wishes to get LMWH treatment,they were divided into three groups named Group A,B and C. 85 patients agreed to use LMWH and 31 patients not agreed. The 42 patients in Group A began the treatment with LMWH three days before surgery. They continue to receive intravenous anti- inflammatory,LMWH and biliary drainage treatment after surgery. The 43 patients in Group B began the treatment of intravenous anti- inflammatory,LMWH and biliary drainage treatment just 3 days after surgery. The 31 patients in Group C received only traditional treatment such as intravenous anti- inflammatory and biliary drainage. The concentrations of plasma D- D level before surgery and7 th,14th,30 th days after surgery were compared. Meanwhile compare the number of complications occurred PVT30 days after surgery. Results On the 7th day after surgery,D- D plasma values in Group A and B were lower than that in group C. The differences were statistically significant（ P〈0. 05）. On the 14 th and 30 th day after surgery,the D- D plasma values in Group A and B were obviously lower than that in group C（ P〈0. 01）. The occurrence rate of PVT in Group A and B was significantly lower than that in the Group C（ P〈0. 01）.Conclusions LMWH can significantly reduce the plasma D- D level and the number of PVT caused by abnormal elevated D- Dimer after surgery of patients suffering from biliary stones and infection. We suggest using LMWH as early as possible when the level of D- D increased.