【摘要】：目的： 探索腹腔鏡脾切斷流術(shù)(LSED)后早期預(yù)防性應(yīng)用低分子肝素(LMWH)對(duì)于預(yù)防術(shù)后門(mén)靜脈血栓(PVST)形成的療效及安全性。 方法： 回顧性分析浙江大學(xué)附屬第一醫(yī)院肝膽胰外科自2012年1月至2015年1月因患肝硬化門(mén)脈高壓癥行腹腔鏡脾切斷流術(shù)的患者,其中符合標(biāo)準(zhǔn)并有完整病例資料的患者共41例,入院完善患者一般資料及各項(xiàng)相關(guān)檢查,將患者肝功能調(diào)整至Child-Pugh分級(jí)B級(jí)以上,并實(shí)施LSED手術(shù),根據(jù)患者術(shù)后是否早期預(yù)防性應(yīng)用低分子肝素抗凝治療分為試驗(yàn)組(LMWH組)及對(duì)照組：LMWH組患者25例,其中男性19例,女性6例；對(duì)照組16例,其中男性10例,女性6例。術(shù)后定期復(fù)查患者肝功能及凝血指標(biāo),并常規(guī)于術(shù)后第1天、出院前及術(shù)后2個(gè)月行彩超檢查,以明確有無(wú)PVST形成。出現(xiàn)門(mén)靜脈系統(tǒng)的血栓,無(wú)論在脾靜脈、腸系膜上靜脈、腸系膜下靜脈或門(mén)靜脈主干任意處部分或完全性附壁血栓,均可診斷為PVST.應(yīng)用SPSS20.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料以x±s表示,兩組間比較采用獨(dú)立樣本t檢驗(yàn)；兩組間分類(lèi)計(jì)數(shù)資料采用χ2檢驗(yàn)或χ2檢驗(yàn)的連續(xù)性校正進(jìn)行數(shù)據(jù)分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 對(duì)照組與LMWH組比較性別、年齡等一般情況,手術(shù)前及術(shù)后肝功能、凝血指標(biāo)無(wú)明顯差異(P0.05)。兩組患者在院期間,對(duì)照組術(shù)后PVST發(fā)生率為56.25%,LMWH組術(shù)后PVST發(fā)生率為12%,兩組患者在住院期間發(fā)生的PVST的概率的差異顯著,具有統(tǒng)計(jì)學(xué)意義(P0.05)；LMWH組未出現(xiàn)出血等與低分子肝素使用相關(guān)的并發(fā)癥；術(shù)后2個(gè)月進(jìn)行復(fù)查彩超檢查,對(duì)照組患者PVST發(fā)生率為68.75%,LMWH組患者發(fā)生PVST發(fā)生率為16%,兩組患者在術(shù)后2個(gè)月內(nèi)發(fā)生PVST的概率的差異顯著,具有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論： 腹腔鏡脾切斷流術(shù)后早期預(yù)防性行低分子肝素抗凝治療可安全有效地預(yù)防門(mén)靜脈血栓形成,并不會(huì)增加患者術(shù)后出血等并發(fā)癥的風(fēng)險(xiǎn)。
[Abstract]:Objective: to investigate the efficacy and safety of early prophylactic application of low molecular weight heparin (LMWH) (LMWH) in prevention of portal vein thrombosis (PVST) after laparoscopic splenectomy (LSED). Methods: the patients undergoing laparoscopic splenectomy in the Department of Hepatobiliary and Pancreatic surgery in the first affiliated Hospital of Zhejiang University from January 2012 to January 2015 were retrospectively analyzed. There were 41 patients who met the standard and had complete case data. The patients' general data and relevant examinations were improved. The liver function of the patients was adjusted to Child-Pugh grade B or above, and LSED operation was performed. According to the early prophylactic use of low molecular weight heparin anticoagulant therapy, the patients were divided into two groups: the experimental group (LMWH group) and the control group (control group). There were 19 males and 6 females in the control group, and 16 patients in the control group (10 males and 6 females). The liver function and coagulation parameters were reexamined regularly after operation. Color Doppler ultrasonography was performed on the first day of operation, before discharge and 2 months after operation to determine whether or not PVST was formed. Portal vein thrombosis can be diagnosed as PVST whether in splenic vein superior mesenteric vein inferior mesenteric vein or portal vein at any part or complete mural thrombus. The statistical analysis was carried out by SPSS20.0 software package, the measurement data were expressed as x 鹵s, and the independent sample t test was used for the comparison between the two groups, and the data were analyzed by the continuity correction of 蠂 2 test or 蠂 2 test for the classified counting data between the two groups. P0.05 as the difference was statistically significant. Results: there was no significant difference between control group and LMWH group in sex, age, liver function and coagulation index before and after operation (P0.05). The incidence of postoperative PVST in the control group was 56.25%. The incidence of postoperative PVST in the two groups was 12. The probability of PVST in the two groups was significantly different (P0.05). There were no complications associated with low molecular weight heparin use in LMWH group, and color Doppler ultrasonography was performed 2 months after operation. The incidence of PVST in the control group was 68.75 and the incidence of PVST in the LMWH group was 16. There was significant difference in the probability of PVST in the two groups within 2 months after operation (P0.05). Conclusion: early prophylactic low molecular weight heparin anticoagulant therapy after laparoscopic splenectomy is safe and effective in preventing portal vein thrombosis and does not increase the risk of complications such as postoperative bleeding.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R657.3

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本文編號(hào)：2176035