抗凝治疗可预防贲门胃底血管离断术后脾切除术后门脾静脉血栓形成。
Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization.
机构信息
Department of Hepatobiliary Surgery and You-An Liver Transplantation Center, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China.
出版信息
World J Gastroenterol. 2012 Jul 14;18(26):3443-50. doi: 10.3748/wjg.v18.i26.3443.
AIM
To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.
METHODS
We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010. Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation, respectively. Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly. Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery, followed by oral warfarin and aspirin for one month regularly. The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50. Platelet and PT/INR were monitored. Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.
RESULTS
The patients' data were collected and analyzed retrospectively. Among the patients, 94 developed early postoperative mural PSVT, including 63 patients in group A (63/153, 41.17%) and 31 patients in group B (31/148, 20.94%). There were 50 (32.67%) patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein. After the administration of thrombolytic, anticoagulant and anti-aggregation therapy, complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.
CONCLUSION
Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization, and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy. Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.
目的
比较不规则抗凝与规则抗凝在贲门周围血管离断术后患者中早期门静脉或脾静脉血栓形成（PSVT）的发生率。
方法
回顾性分析 2004 年 4 月至 2010 年 7 月因肝硬化行贲门周围血管离断术的 301 例门静脉高压患者。患者分为 A 组（153 例）不规则抗凝组和 B 组（148 例）规则抗凝组。A 组（153 例）患者接受抗凝治疗时间不定，或仅用阿司匹林或华法林，而未使用低分子肝素（LMWH）。B 组（148 例）患者术后 5 天内皮下注射 LMWH，随后常规口服华法林和阿司匹林 1 个月。目标凝血酶原时间/国际标准化比值（PT/INR）为 1.25-1.50。监测血小板和 PT/INR。彩色多普勒超声检查监测 PSVT 及溶栓治疗效果。
结果
回顾性收集和分析患者资料。术后早期发生门静脉壁 PSVT 94 例，A 组 63 例（63/153，41.17%），B 组 31 例（31/148，20.94%）。A 组主门静脉壁 PSVT 50 例（32.67%），B 组 27 例（18.24%）。A 组 50 例（79.37%）和 B 组 26 例（83.87%）溶栓、抗凝和抗聚集治疗后血栓完全或部分溶解。
结论
贲门周围血管离断术后患者行规则抗凝治疗可降低 PSVT 的发生率，规则抗凝治疗较不规则抗凝治疗更安全、有效。早期、及时溶栓治疗对预防 PSVT 至关重要且可行。
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