脾切断流术后不同血小板水平开始抗凝对门静脉系统血栓形成的影响

Impact of anticoagulant therapy starting at different platelet levels on the incidences of portal vein thrombosis after splenectomy and devascularization

目的研究脾切断流术后不同血小板水平开始抗凝治疗对门静脉系统血栓形成的影响。方法选取从2014年1月至2017年1月在首都医科大学附属北京地坛医院因肝硬化门静脉高压症接受脾切断流术的患者125例,患者术后均常规抗凝治疗,其中血小板>100×10^(9)/L开始抗凝的患者85例为实验组,血小板>300×10^(9)/L开始抗凝的患者40例为对照组,以术后1个月内门静脉系统血栓发生率为主要评价指标,对两组患者术后门静脉系统血栓发生情况进行比较。结果125例患者中男性91例,女性34例,年龄20~59岁。两组患者在年龄、性别、术前血小板水平、术前脾静脉及门静脉宽度、术前凝血功能、术前Child分级、术前食管胃底静脉曲张程度、手术时间、术前出血次数、术前静脉血流速度、术后1周和2周时的凝血功能方面差异均无统计学意义(均P>0.05)。125例患者术前均未合并门静脉系统血栓,术后1个月内血栓发生率为39.2%(49/125),其中实验组血栓发生率为32.9%(28/85),对照组血栓发生率为52.5%(21/40),两组比较差异有统计学意义(χ^(2)=4.366,P=0.037)。实验组出血率4.7%(4/85),对照组5.0%(2/40),两组比较差异无统计学意义(P>0.05)。结论脾切断流术后的肝硬化门静脉高压患者早期开始抗凝(血小板>100×10^(9)/L)无明显增加术后出血风险,但可降低门静脉系统血栓发生概率。

Objective To study the impact of anticoagulant therapy starting at different platelet levels on the incidences of portal vein thrombosis(PVT)after splenectomy and devascularization.Methods From January 2014 to January 2017,125 patients with liver cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization in Beijing Ditan Hospital,Capital Medical University.All patients routinely received anticoagulant therapy.There were 85 patients who had a platelet count greater than>100×10^(9)/L(the study group)and 40 patients who had a platelet count greater than>300×10^(9)/L(the control group).The incidence of PVT was compared between the two groups.Results A total of 125 patients were included in the study,including 91 males and 34 females,aged 20-59 years.Age,gender,preoperative platelet level,preoperative splenic vein and portal vein width,preoperative coagulation function,preoperative liver function(Child classification),preoperative esophageal and gastric varices,operation time,preoperative bleeding time,preoperative venous blood flow velocity,coagulation function 1 week and 2 weeks after operation between the two groups were not significantly different(all P>0.05).Of 125 patients undergoing splenectomy and pericardial devascularization,PVT was not found in all patients before operation.The incidence of PVT was 39.2%(49/125)within one month after operation.Among the 85 patients in the study group,28 patients developed PVT,and the incidence of thrombosis was 32.9%(28/85).In the control group,21 patients developed PVT,and the thrombosis rate was 52.5%(21/40).The difference was significant(χ^(2)=4.366,P=0.037).After anticoagulant therapy,the incidence of bleeding in the study group was 4.7%(4/85),and that in the control group was 5.0%(2/40),the difference was no significant(P>0.05).Conclusion Early anticoagulation(platelet>100×10^(9)/L)does not increase the risk of postoperative bleeding,but can reduce the incidence of PVT.