脾切断流术后预防门静脉系血栓行抗凝治疗时机选择的临床研究

目的探索脾切断流术后行抗凝治疗预防门脉系血栓形成的最佳时机及安全性。方法选取择期行脾切断流术的肝硬化门脉高压症患者90例，随机分成三组。A组：行祛聚治疗基础上，术后第2天开始加用低分子肝素钠。B组：行祛聚治疗基础上，血小板计数〉300×10-9／L时加用低分子肝素钠行抗凝治疗。c组：仅行祛聚治疗。比较三组间血栓发生率、术后再出血等不良反应情况。结果A组术后门静脉系统血栓发生率（3．39％）明显低于B组（25．93％，P〈0．05）和C组（35．71％，P〈0．05）。B组和C组间血栓发生率比较差异无统计学意义（X2=0.6167，P〉0．05）。三组患者治疗期间均无明显出血等不良反应。结论术后尽早（术后第2天）行抗凝治疗预防断流术后门静脉系血栓形成效果佳，且安全、方便。

Clinical study of the timing selection of anticoagulant therapy in the prevention of portal venous system thrombosis after splenectomy and devascularization

Objective To study the best time and operating security of anticoagulant therapy in the prevention of portal venous system thrombosis （PVT） for patients underwent splenectomy and porta-az- ygous devascularization. Methods Ninety patients with liver cirrhosis and portal hypertension who need to have spleneetomy and porta-azygous devascularization were randomly divided into three groups. Group A：based on anticoagulation therapy, on the second day after surgery, low molecular weight heparin sodi- um（LMWHS） was given. Group B ： based on anticoagulant therapy, low molecular weight heparin sodium （LMWHS） was given when platelet exceeded 300 × 109/L after operation. Group C： just use the basic anticoagulant therapy. The side effects such as incidence of thrombosis, postoperative hemorrhage were compared. Results The incidence rate of portal venous system thrombosis in group A （3.39%） was ob- viously lower than that in group B（25.93% ,P 〈0.05） and group C（35.71% ,P 〈0.05）, but there was no significant difference between group B and group C （ ~2 = 0. 6167, P 〉 0.05 ）. There was no side effect during treatment. Conclusions It is better to use antieoagulation therapy early（on the second day after surgery） to prevent the formation of portal vein thrombosis, and it is safe and convenient.