Shpitz Baruch, Plotkin Eleanora, Spindel Zvi, Buklan Genadi, Klein Ehud, Bernheim Jacques, Korzets Ze'ev
Department of Surgery B, Meir General Hospital, Sapir Medical Center, Kfar-Saba, Israel.
Am Surg. 2002 Sep;68(9):762-4.
The necessity of withdrawal of aspirin [acetylsalicylic acid (ASA)] for fear of perioperative or postoperative bleeding in patients about to undergo surgery is as yet controversial. In this study we prospectively evaluated the effect of ASA on postoperative bleeding in end-stage renal failure patients who underwent insertion, removal, and/or replacement of a peritoneal dialysis (PD) catheter at our institution from November 1999 to March 2001. During the study period 52 of the above procedures were consecutively performed in 46 patients. Patients whose catheters were removed as a result of refractory peritonitis were excluded from the study. In all cases the PD catheter used was the coiled two-cuff Tenckhoff (NIPRO, Manchester, GA) catheter and the surgery was performed in the operating room under local anesthesia. No drains were left in the operating wound. Postoperative bleeding (wound hematoma or persistent oozing from the incision or exit site) was classified as either minor (requiring no professional intervention and/or blood replacement) or major [necessitating blood transfusion (> or = 1 unit red blood cells). Of the 52 procedures 29 (in 24 patients) were performed while the patient was receiving aspirin at the time of operation (aspirin group). The remaining 23 were without aspirin and constituted the control group. ASA dose was 100 mg/day in all but three who were on buffered ASA (325 mg/day). The groups were well matched with regard to age; sex; mean residual renal function; and preoperative international normalized ratio, activated partial thromboplastin time, and platelet count. In no case was there significant intraoperative bleeding. There were five (17.2%) and three (13.0%) minor bleeds in the aspirin group and control group, respectively. One major bleed occurred in the control group ending in an exploratory laparotomy. Of the nine bleeding complications six were observed after catheter removal. From these data we conclude that PD catheter insertion/removal can be safely performed under conventional low-dose aspirin therapy.
对于即将接受手术的患者，因担心围手术期或术后出血而停用阿司匹林[乙酰水杨酸（ASA）]的必要性目前仍存在争议。在本研究中，我们前瞻性评估了ASA对1999年11月至2001年3月在我院接受腹膜透析（PD）导管插入、拔除和/或更换的终末期肾衰竭患者术后出血的影响。研究期间，46例患者连续进行了上述52项操作。因难治性腹膜炎而拔除导管的患者被排除在研究之外。所有病例均使用螺旋双套Tenckhoff（NIPRO，曼彻斯特，佐治亚州）导管，手术在手术室局部麻醉下进行。手术伤口未留置引流管。术后出血（伤口血肿或切口或出口部位持续渗血）分为轻微出血（无需专业干预和/或输血）或严重出血[需要输血（≥1单位红细胞）]。在52项操作中，29项（24例患者）是在患者手术时正在服用阿司匹林的情况下进行的（阿司匹林组）。其余23项操作未服用阿司匹林，构成对照组。除3例服用缓冲ASA（325mg/天）的患者外，所有患者的ASA剂量均为100mg/天。两组在年龄、性别、平均残余肾功能以及术前国际标准化比值、活化部分凝血活酶时间和血小板计数方面匹配良好。所有病例术中均无明显出血。阿司匹林组和对照组分别有5例（17.2%）和3例（13.0%）轻微出血。对照组发生1例严重出血，最终进行了剖腹探查。在9例出血并发症中，6例是在导管拔除后观察到的。根据这些数据，我们得出结论，在常规低剂量阿司匹林治疗下，PD导管的插入/拔除可以安全进行。
