腹腔镜脾切除术后抗凝治疗预防门静脉系统血栓的Meta分析

Postoperative prophylactic anticoagulation in the prevention of portal venous thrombosis in patients after laparoscopic splenectomy： a Meta-analysis

目的探讨腹腔镜脾切除术后抗凝治疗预防门静脉系统血栓的有效性及安全性。方法在Pubmed、Embase、Cochranelibrary、Sinomed、万方、维普、中国知网数据库中检索2007年8月至2017年8月期间腹腔镜脾切除术后使用抗凝药物预防门静脉系统血栓形成的文献。质量评估采用Cochrane偏倚风险评估工具及纽卡斯尔-渥太华质量评价量表。异质性分析采用χ2和I2检验。主要指标为门静脉系统血栓发生率。结果五项研究最终入选，其中接受抗凝药物患者为206例、未接受抗凝药物患者为168例。用随机效应模型合并各文献，结果显示两组患者门静脉血栓发生率（OR=0．32，95％CI：0．13～0．79，P〈0．05），差异有统计学意义。结论Meta分析结果表明，腹腔镜脾切除术后患者门静脉系统血栓发生的降低与预防性使用抗凝药物有关。

Objective To study the effectiveness and safety of prophylactic anticoagulation in the prevention of portal venous thrombosis （PVST） in patients after laparoscopic splenectomy. Methods A systematic search of the PubMed, Embase, Coehrane Library, Sinomed, Wangfang, Weipu and CNKI databases was performed to identify studies which compared outcomes in patients with or without prophylactic anticoagulation after laparoseopic splenectomy. The quality of the included studies was assessed using the Cochrane collaboration tool and the Newcastle-Ottawa Scale. Heterogeneity was evaluated using the χ2 and I2 tests. The primary outcome was the incidence of postoperative PVST. Results Five studies were included into this review, which involved 206 and 168 patients with or without prophylactic anticoagulation, respectively. The incidence of PVST was significantly reduced with prophylactic anticoagulation with an odds ratio （OR） of 0.32 [95% confidence interval （CI）, 0. 13 -0.79, P〈0.05]. Conclusion Prophylactic anti- coagulation resulted in a significant reduced incidence of PVST after laparoscopic splenectomy.