CAJ | 학술논문

目的研究脾切除术后早期接受抗凝治疗对预防门静脉血栓形成的效果.方法对行脾切除+贲门周围血管离断术的140例患者按随机数字表法分为抗凝组(76例)和对照组(64例),抗凝组术后早期根据血小板计数予以川芎嗪、阿司匹林、低分子量肝素等药物进行早期抗凝治疗;对照组术后早期不进行抗凝治疗,术后监测血小板计数及D-二聚体,B超或CT检查是否存在门静脉血栓.结果抗凝组和对照组在脾切除术后第2天血小板计数、D-二聚体水平均显著上升,与术前比较差异有统计学意义[抗凝组:(95.73±28.06)×109/L比(38.41±11.96)×109/L、(3.61±0.18) mg/L比(0.42±0.09) mg/L,对照组:(92.56±27.25)×109/L比(35.13±11.38)×109/L、(3.26±0.16) mg/L比(0.37±0.09) mg/L,P＜ 0.05].术前及术后第2天两组血小板计数、D-二聚体水平比较差异均无统计学意义(P＞0.05).术后对照组发生门静脉血栓10例,抗凝组发生门静脉血栓3例,抗凝组门静脉血栓发生率[3.95％(3/76)]与对照组[15.62％(10/64)]比较差异有统计学意义(P＜0.05).结论门静脉高压症脾切除术后早期抗凝治疗是预防门静脉血栓形成的有效方法.
목적 연구비절제술후조기접수항응치료대예방문정맥혈전형성적효과.방법 대행비절제+분문주위혈관리단술적140례환자안수궤수자표법분위항응조(76례)화대조조(64례),항응조술후조기근거혈소판계수여이천궁진、아사필림、저분자량간소등약물진행조기항응치료;대조조술후조기불진행항응치료,술후감측혈소판계수급D-이취체,B초혹CT검사시부존재문정맥혈전.결과 항응조화대조조재비절제술후제2천혈소판계수、D-이취체수평균현저상승,여술전비교차이유통계학의의[항응조:(95.73±28.06)×109/L비(38.41±11.96)×109/L、(3.61±0.18) mg/L비(0.42±0.09) mg/L,대조조:(92.56±27.25)×109/L비(35.13±11.38)×109/L、(3.26±0.16) mg/L비(0.37±0.09) mg/L,P＜ 0.05].술전급술후제2천량조혈소판계수、D-이취체수평비교차이균무통계학의의(P＞0.05).술후대조조발생문정맥혈전10례,항응조발생문정맥혈전3례,항응조문정맥혈전발생솔[3.95％(3/76)]여대조조[15.62％(10/64)]비교차이유통계학의의(P＜0.05).결론 문정맥고압증비절제술후조기항응치료시예방문정맥혈전형성적유효방법.
Objective To study the effect of postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension.Methods One hundred and forty patients with cirrhosis and portal hypertension receiving splenectomy and periesophagastric devascularization were divided into anticoagulant group (76 cases) and control group (64 cases) by random number table,patients in anticoagulant group received postoperative anticoagulant therapy,principally according to the platelet count,gave ligustrazine,aspirin,low molecular heparin after operation; patients in control group without postoperative anticoagulant therapy.Postoperative monitoring platelet count and D-dimer,ultrasound or CT check the presence of portal vein thrombosis.Results Platelet count,D-dimer levels in anticoagulant group and control group in 2 days after operation were significantly increased,the difference was significant compared with preoperative [anticoagulant group:(95.73 ± 28.06) × 109/L vs.(38.41 ± 11.96) × 109/L,(3.61 ± 0.18) mg/L vs.(0.42 ± 0.09) mg/L;control group:(92.56 ± 27.75) × 109/L vs.(35.13 ± 11.38) × 109/L,(3.26 ± 0.16) mg/L vs.(0.37 ± 0.09) mg/L,P ＜ 0.05].Platelet count and D-dimer levels between two groups at preoperative and postoperative in 2 days had no statistical significance (P ＞ 0.05).Ten cases of control group occurred postoperative portal vein thrombosis,anticoagulant group were 3 cases,portal vein thrombosis incidence of anticoagulant group [3.95％ (3/76)] compared with control group [15.62％(10/64)] was statistically significant (P ＜ 0.05).Conclusion Postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension is an effective method to prevent portal vein thrombosis.