门静脉高压症贲门周围血管离断术后预防性抗凝对门静脉系统血栓形成的影响

Analysis of portal vein thrombosis of portal hypertension after pericardial devascularization by prophylactic anticoagulation

目的 分析门静脉高压症患者实施贲门周围血管离断术后给予预防性抗凝对门静脉系统血栓形成(PVT)的影响.方法 选择我院2009年1月至2014年12月收治的乙型肝炎肝硬化门静脉高压症患者86例,均给予贲门周围血管离断术治疗,以是否术后给予预防性抗凝治疗将其分为观察组(给予抗凝治疗,46例)与对照组(未给予抗凝治疗,40例),对比两组术后并发PVT的情况及临床特征.结果 观察组术后PVT的发生率为10.9％ (5/46),PVT分级中Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为2、3、0、0例;而对照组的发生率为32.5％(13/40),PVT分级中Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为4、7、2、0例,观察组发生率低于对照组(x2=9.735,P＜0.05).两组患者中是否并发PVT,与年龄、性别构成、术中是否结扎脾动脉无关(P均＞0.05);而与术后血小板峰值、门静脉血流方向有关(P均＜0.05).PVT患者经溶栓治疗有效均顺利出院,其中血栓溶解2例,血运再通4例,无一例死于PVT.结论 门静脉高压症患者实施贲门周围血管离断术后给予预防性抗凝治疗能显著降低PVT,门静脉离肝血流及术后血小板峰值(300～499)×109/L是并发PVT的重要因素,早期发现、及时溶栓治疗是诊治PVT的关键.

Objective To explore the effect of pathogenesis,diagnosis,therapy and prevention of portal vein thrombosis(PVT) after devascularization.Methods Data of 86 patients who underwent devascularization because of cirrhotic portal hypertension between January 2009 and December 2014 were retrospectively analyzed.Patients were divided into preventive anticoagulant treatment group (46 cases) and nonpreventive anticoagulant treatment group (40 cases) according to whether or not to receive prophylactic anticoagulant therapy.Compared the causes of PVT and clinical characters.Results The occurrence of PVT was 10.9％ (5/ 46) in preventive anticoagulant treatment group,PVT Ⅰ , Ⅱ, Ⅲ, Ⅳdegree were 2,3,0,0 cases,and that was 32.5％ (13/40) in nonpreventive anticoagulant treatment group, PVT Ⅰ , Ⅱ , Ⅲ, Ⅳ degree were 4,7,2,0 cases, the incidence rate of treatment group was lower than control group (x2 =9.735, P ＜ 0.05).There was no relationship in PVT with sex, age, and intraoperative ligation of splenic artery beforehand (P＞0.05).There were apparent correlation in PVT with centrifugal-flow of portal vein and peak value of platelet count(P＜0.05).All patients discharged uneventfully after anticoagulant treatment, including 2 cases of thrombolytic and 4 cases of blood supply recanalization, no case died from PVT.Conclusion The definite cause of PVT after devascularization is centrifugal-flow of portal vein and the peak value of platelet count (300-499) × 109/L is a pivotal risk factor.The key point of therapy is early diagnosis and early anticoagulant treatment.