脾切除断流术后早期经脾静脉抗凝预防门静脉血栓形成

目的评价术后早期经脾静脉抗凝治疗对门脉高压症脾切除断流术后门静脉血栓形成的预防效果及安全性。方法 63例行择期脾切除断流术的门脉高压上消化道出血患者随机分为经脾静脉抗凝组和常规治疗组,采用超声多普勒和/或强化螺旋CT扫描监测术后门静脉血栓形成情况。结果共58例患者完成3个月随访,其中抗凝组27例,对照组31例。抗凝组术后14d内无门静脉血栓形成,3个月内发生门静脉血栓1例,累计发生率7.4%。对照组术后14d内发生门静脉血栓4例,术后3个月内发生门静脉血栓形成3例,累计发生率22.6%。两组患者术后3个月内门静脉血栓发病率有显著性差异(P<0.05)。经脾静脉以200U/h的剂量输入肝素溶液对体循环静脉血凝血酶原时间和活化部分凝血活酶时间无影响。结论断流术后经脾静脉置管早期灌注肝素抗凝能有效降低门脉高压脾切除断流术后门静脉血栓发生率。以200U/h的剂量经脾静脉输入肝素是安全的,不增加术后出血性并发症的发生率。

Through spleen vein early anticoagulation to prevent portal vein thrombosis after splenectomy and esophagogastric devascularization

Objective To evaluate the efficacy and safety of early anticoagulation via spleen vein in preventing portal vein thrombosis (PVT) after splenectomy and esophagogastric devascularization. Methods The 63 patients treated with splenectomy and esophagogastric devascularization were randomized into two groups: early anticoagulation group (i. e early infusion of heparin) and conventional treatment group. Color Doppler ultrasonography and/or CT were used for diagnosis of PVT. Results Among 63 cases 58 patients had finished investigation, including 27 cases with early anticoagulation therapy and 31 cases with conventional treatment. In conventional treatment group,the tortal PVT rate within 3 months was 22.6%(7/31) and in early anticoagulation group 7.4%(1/ 27). PVT rate was significantly reduced in early anticoagulation group in contrast with conventional treatment group (P <0.05). Heparin infusion of 200 U/h through spleen vein had no side -effect. Conclusion Early infusion of heparin through spleen vein is effective and safe in preventing portal vein thrombosis after splenectomy and esophagogastric devascularization.