回顧性分析脾切除加賁門周圍血管離斷術(shù)后早期抗凝治療的效果

[摘要] 探討脾切除加賁門周圍血管離斷術(shù)后早期使用抗凝治療的效果及安全性。方法 回顧性分析2010年1月一2016年6月該院收治的53例肝硬化門靜脈高壓癥行脾切除、賁門周圍血管離斷術(shù)的病例，根據(jù)術(shù)后是否早期抗凝治療分為對照組、觀察組（早期抗凝治療）兩組，統(tǒng)計并比較兩組患者術(shù)后PVT發(fā)生率、PLT、PT、APTT、腹腔引流液量的變化。觀察術(shù)后是否有出血等并發(fā)癥。結(jié)果 觀察組患者術(shù)后門靜脈血栓形成率顯著低于對照組（5.6% VS 29.4%，P<0.05），腹腔引流量明顯減少，且治療期間PLT、PT、APT差異無統(tǒng)計系意義，未發(fā)生消化道出血和創(chuàng)面出血。結(jié)論 脾切除加賁門周圍血管離斷術(shù)后早期抗凝治療安全、有效，可減少門靜脈血栓的發(fā)生。

[關(guān)鍵詞] 門脈高壓；脾切除；賁門周圍血管離斷術(shù)；門靜脈系統(tǒng)血栓；抗凝

[中圖分類號] R657.3 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-0742（2016）11（c）-0063-03

[Abstract] Objective To investigate the effect and security of the early use of anticoagulant drugs after splenectomy and esophagogastric devascularization. Methods The clinical data of 53 patients with portal hypertension receiving splenectomy and esophagogastric devascularization from January 2010 to June 2016 were analyzed retrospectively. The cases were divided into control group and observational group with early use of anticoagulant drugs. The rate of postoperative thrombosis， PLT， PT， APTT， volume of intraperitoneal drainage were compared among the two groups. Observe postoperative bleeding and other complications. Results After surgery， the control group， the incidence of portal vein thrombosis was 29.4%， the observational group， the incidence was 5.6%， and the difference has significant statistical significance （P < 0.05）. Experimental group has no bleeding and other complications related to the use of anticoagulant drugs. Conclusion Early postoperative application of anticoagulant drugs after splenectomy and esophagogastric devascularization was safe and effective， could reduce portal vein thrombosis after splenectomy.

[Key words] Portal hypertension； Splenectomy； Portal vein thrombosis； Esophagogastric devascularization； Anticoagulant

肝硬化門靜脈高壓癥首選的外科治療是脾臟切除聯(lián)合門奇靜脈聯(lián)合斷流術(shù)，在斷流術(shù)中以賁門周圍血管離斷術(shù)的療效較好。而門靜脈系統(tǒng)血栓形成（portal vein thrombosis，PVT）是脾切除斷流術(shù)后的常見并發(fā)癥，其發(fā)生率可高達(dá)到22.2%～37.5%[1]。處理不及時或不恰當(dāng)，有增加肝功能損害、上消化道出血以及腸壞死風(fēng)險，嚴(yán)重可致命[2]。因此積極預(yù)防門靜脈系統(tǒng)血栓形成有重要的臨床意義。該文回顧性分析鹽城市第二人民醫(yī)院2010年1月—2016年6月收治的53例肝硬化門靜脈高壓癥行脾切除、賁門周圍血管離斷術(shù)的病例，現(xiàn)報道如下。

1 資料與方法

1.1 一般資料

全組均為乙肝肝硬化門靜脈高壓癥患者，并發(fā)脾腫大功能亢進(jìn)、食管靜脈曲張。……