低分子肝素预防原发性肝癌切除术后静脉血栓形成的临床观察

目的：评价低分子肝素在原发性肝癌切除术后预防静脉血栓形成的疗效及安全性。方法：将105例行原发性肝癌切除治疗的患者随机分为抗凝组48例，术后第2～7天每天皮下注射低分子肝素5 000 U；非抗凝组57例，术后未行皮下注射低分子肝素治疗。统计两组患者术后静脉血栓(venous thromboemolism，VET)形成发生率、腹腔出血发生率、切口渗血及切口周围皮肤瘀斑发生率，监测术后第1天和第6天血红蛋白量变化及术后第6天凝血功能，统计术后腹腔引流液总量，行统计学分析。结果：抗凝组术后未见VTE发生(0/48)；非抗凝组术后发生5例VTE，发生率8.87%(5/57)；抗凝组VTE术后发生率较非抗凝组显著降低(P=0.043)。抗凝组和非抗凝组术后腹腔活动性出血发生率、血红蛋白变化量、腹腔引流总量、凝血功能、出现切口渗血及切口周围皮肤瘀斑等指标之间无显著性统计学差异(P>0.05)。结论：原发性肝癌切除术后易伴发VTE，低分子肝素预防原发性肝癌切除术后VTE疗效确切且安全。

The clinical preventive effectcs of low molecular weight heparin as prophylaxis against venous thromboembolism after primary hepatocellular carcinoma surgery

Objective: To investigate the efficacy and security of low molecular weight heparin (LMWH) as prophylaxis against venous thromboembolism (VTE) after primary hepatocellular carcinoma (PHC) surgery. Methods: One hundred and five patients who received PHC surgery were randomly designated to either anticoagulation therapy group (48 cases) or non-anticoagulation therapy group (57 cases). In the anticoagulation therapy group, the patients were subcutaneously injected with LMWH 5 000 U per day from 2nd day to 7th day after operations; however the patients in the non-anticoagulant therapy group were not received the anticoagulant therapy of LMWH after operation. The incidence of postoperative VTE, intra-abdominal hemorrhage, incision bleeding and skin ecchymosis around incision of the two groups were counted. Coagulation function in the 6th day and hemoglobin on the 1st and 6th day after operations were collected. The total abdominal drainage of the two groups was calculated after operation. Finally, a statistical comparison was made between two groups. Results: In the anticoagulant therapy group, there was no patients suffering from VTE (0/48). However, there were 5 patients suffering from VTE in the non-anticoagulant therapy group (5/57), which indicated the incidence of VTE was 8.87%. LMWH significantly decreased the incidence of VTE (P=0.043). Furthermore, there are no significantly statistical differences on the aspects of intra-abdominal hemorrhage, hemoglobin variation, abdominal drainage, coagulation function, incision bleeding and skin ecchymosis around incision between the two groups(P>0.05). Conclusion: Our study indicates that PHC surgery often leads VTE, which could be effectively and safely treated by LMWH.