早期应用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术后门静脉血栓形成临床研究

Clinical study of low molecular weight heparin in early prevention of portal vein thrombosis in patients with liver cirrhosis after laparoscopic splenectomy with esophagogastric devascularization

目的研究早期使用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术(LSED)治疗患者术后门静脉血栓(PVST)发生的作用。方法我院2014年3月至2015年6月期间收治的112例肝硬化门静脉高压症(PHT)患者,所有患者均行LSED治疗,按患者入院顺序分为两组,每组56例,对照组56例患者采用常规抗凝治疗,另56例患者在上述基础上采用低分子肝素治疗(观察组)。随访两组患者两周,观察两组患者肝功能、门静脉血流状况、凝血功能、PVST以及并发症发生情况。结果两组患者治疗前后血清TBIL、ALB、INR水平均无显著性差异(P>0.05);治疗前两组患者门静脉最大血流速度、平均血流速度和门静脉直径无明显差异(P>0.05);治疗后观察组患者门静脉最大血流速度、平均血流速度和门静脉直径分别为(20.83±1.15)cm/s、(15.12±1.19cm/s)和(15.86±3.12)mm,均大于对照组的上述指标【分别为(14.36±0.74)cm/s、(10.28±0.71)cm/s和(14.27±2.96)mm,P<0.05】;治疗前两组患者凝血功能指标比较无显著差异(P>0.05);治疗后,观察组患者血APTT、PT、FIB和TT分别为(25.72±3.64)s、(14.96±2.26)s、(3.51±0.86)g/L和(20.11±3.65)s,均长于对照组的上述指标【分别为(23.37±3.52)s、(13.87±2.14)s、(2.62±0.73)g/L和(18.14±3.23)s,均P<0.05】;术后观察组和对照组PVST发生率分别为7.14%和42.86%,观察组明显较低(P<0.05),观察组和对照组其他并发症发生率无显著相差(P>0.05)。结论早期应用低分子肝素对预防LSED术后门静脉血栓具有良好的作用,能有效改善凝血功能,同时降低各种并发症,安全性高。

Objective To study the effect of early application of low molecular weight heparin on the formation of portal vein thrombosis （PVST） in patients with liver cirrhosis after laparoscopic splenectomy and esophagogastric devascularization （LSED）. Methods 112 patients with liver cirrhosis and portal hypertension （PHT） were admitted to our hospital from March 2014 to June 2015. All patients were treated with LSED. The patients were divided into two groups according to the order of admission,with 56 in each group. Among them,56 patients were treated as control group,and 56 patients were treated with low molecular weight heparin as the observation group. The two groups of patients were followed-up for two weeks. Serum liver function tests, portal vein blood flow,blood coagulation function,PVST occurrence and complications were observed in the two groups. Results Before and after treatment,serum TBIL,ALB and INR levels in the two groups were not significantly different （P〉0.05）;Before treatment,there was no significant difference in the maximum blood flow velocity,mean blood flow velocity and portal vein diameters between the two groups （P〉0.05）;After treatment,the maximum blood flow velocity,mean blood flow velocity and portal vein diameter in the observation group were （20.83±1.15）cm/s,（15.12±1.19） cm/s,and （ 15.86±3.12） mm,much higher than （14.36±0.74） cm/s,（10.28±0.71） ends, and （ 14.27 ±2.96）ram,respectively,in the control group （P〈0.05）;after treatment the APTT,Pt,FIB and TT in the observation group were （25.72±3.64） s, （14.96 ±2.26） s,（3.51±0.86） g/L,and （20.11±3.65） s,much longer than those in the control group,[（23.37±3.52） s,（13.87±2.14） s,（2.62±0.73） g/L,and （18.14±3.23） s,respeetively,all P〈0.05];The incidences of PVST in the observation group and in the control group were 7.14% and 42.86%,respectively,and the difference was significantly （P〈0.05）;the incidence of other complications in the observation group and in the control group were not significantly different （/±〉0.05）. Conclusion Early application of low molecular weight heparin for the prevention of PVST after LSED postoperatively has a good effect, which might effectively improve the coagulation function and safe in clinical practice.