目的 分析低分子肝素钙联合阿司匹林预防断流术后门静脉血栓(PVT)形成的临床疗效.方法 采用回顾性队列研究方法.收集2014年12月至2017年4月复旦大学附属中山医院61例门静脉高压症患者资料,男性43例,女性18例,年龄24~74岁.两组均行脾切除+贲门周围血管离断术或联合断流术.根据术后抗凝方式分为治疗组(低分子肝素钙联合阿司匹林,n=31)和对照组(仅阿司匹林,n =30).术后随访血小板计数、凝血酶原时间及Child-Pugh评分,PVT情况及手术相关并发症.结果 两组术后7、14、30、60、90d血小板计数和凝血酶原时间比较,差异无统计学意义(P>0.05).两组术后3、7、14、30、60、90d Child-Pugh评分比较,差异无统计学意义(P>0.05).术后7d,治疗组和对照组PVT分别为7例(22.6%)和7例(23.3%).术后30 d,治疗组PVT 8例(25.8%),对照组15例(50.0%).术后60d,治疗组PVT 6例(19.4%),对照组13例(43.3%).术后90d,治疗组PVT4例(12.9%),对照组12例(40.0%).术后30、60、90d治疗组PVT发生率低于对照组,差异有统计学意义(P<0.05),且血栓程度较轻.对照组发生并发症6例(20.0%),治疗组6例(19.4%),两组比较差异无统计学意义(P>0.05).结论 采用低分子肝素钙联合阿司匹林预防门静脉高压症断流术后PVT形成安全有效.
Objective To analyze the clinical effect of low molecular weight heparin calcium (LMWH) combined with aspirin in preventing portal venous thrombosis (PVT) after devascularization.Methods Retrospective cohort study was carried out.A total of 61 patients with portal hypertension in Zhongshan Hospital affiliated to Fudan University from December 2014 to April 2017 were included in the study,including 43 males and 18 females,aged 24 ~ 74 years.According to anticoagulation methods,the patients were divided into treatment group (31 cases of LMWH combined with aspirin) and control group (30 cases of aspirin).Splenectomy and pericardial devascularization or combined devascularization were performed in both groups.Platelet count,prothrombin time,Child-Pugh score,PVT status and surgical complications were observed after surgery.Results There were no significant differences for platelet count and prothrombin time between the two groups after 7,14,30,60 and 90 days (P > 0.05).Child-Pugh scores at 3,7,14,30,60 and 90 d after operation of the two groups showed no significant differences (P >0.05).Seven days after the operation,PVT in the treatment group and control group was 7 (22.6%) and 7 (23.3%),respectively.Thirty days after the operation,PVT was detected in 8 patients (25.8%) in the treatment group and 15 patients (50.0%) in the control group.Sixty days after the operation,6 patients (19.4%) had PVT in the treatment group and 13 patients (43.3%) in the control group.PVT was detected in 4 patients (12.9%) in the treatment group and 12 patients (40.0%) in the control group 90 days after operation.The incidence of PVT in the 30,60 and 90 days after surgery was lower than that in the control group,with significant difference (P < 0.05),and the degree of thrombosis was relatively mild.There were 6 cases (20.0%) of complications in the control group and 6 cases (19.4%) in the treatment group,there were no significant differences between the two groups (P > 0.05).Conclusion LMWH combinedwith aspirin is safe and effective in preventing PVT after devascularization.