脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症患者预防门静脉血栓形成研究

目的 探讨脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症患者门静脉血栓(PVT)的预测措施。方法 2017年1月～2019年3月我院肝胆外科诊治的肝硬化并发门脉高压症患者60例,均接受脾切除联合贲门周围血管离断术。术后将患者分成A组和B组。在B组,当出现抗凝指针时给予低分子肝素短期抗凝治疗。使用彩超检查门脉指标和诊断PVT形成。结果 术后,在B组30例患者中有20例(66.7%)接受了短期抗凝治疗;在术后3 w末,超声检查发现PVT患者15例(25.0%),其中A组11例(36.7%),显著高于B组的4例【(13.3%),P<0.05】;血栓形成组门静脉直径为(1.5±0.3)cm,与无血栓形成组比,无显著性差异【(1.4±0.2)cm,P>0.05】,门静脉血流流速为(12.3±1.4)cm/s,显著低于无血栓形成组【(14.5±1.7)cm/s,P＜0.05】;血栓形成组血清D-二聚体水平显著高于无血栓形成组(P＜0.05);血栓形成组外周血血小板计数为(142.6±58.9)×10⁹/L,显著高于无血栓形成组【(91.4±52.4)×10⁹/L,P＜0.05】。结论 在采取脾切除联合贲门周围血管离断术治疗肝硬化并发门脉高压症患者时,需警惕术后PVT的形成。对术后血小板计数急剧升高、血清D-二聚体显著升高和门脉血流减慢的患者应该及时给予抗凝治疗。

Prevention of portal vein thrombosis in patients with cirrhotic portal hypertension aftersplenectomy and devascularization

Objective The aim of this study was to investigate the prevention of portal vein thrombosis(PVT)in patients with cirrhotic portal hypertension after spleen resection and devascularization.Methods 60 patients with cirrhotic portal hypertension were recruited in our hospital between January 2017 and March 2019,and all underwent splenectomy and periorbital devascularization.After operation,the patients were randomly divided into group A(n=30)and group B(n=30),and the patients in group B were given very short-term anti-coagulant therapy when any parameters suggesting necessary.Results 20 patients(66.7%)out of 30 in group B received anti-coagulant therapy after operation,and at the end of three weeks,the sonography demonstrated PVT in 15 patient(25.0%),11(36.7%)in group A and 4【(13.3%),P<0.05】in group B;the portal diameter in patients with PVT was(1.5±0.3)cm,not significantly different compared to【(1.4±0.2)cm,P>0.05】in those without PVT,while the blood velocity in patients with PVT was(12.3±1.4)cm/s,much slower than【(14.5±1.7)cm/s,P<0.05】in patients without;serum D-dimer level in patients with PVT was much higher than that in patients without PVT(P<0.05);the platelet count in patients with PVT was(142.6±58.9)×109/L,significantly higher than thatin those without(91.4±52.4)×109/L,P<0.05].Conclusion The application of splenectomy and devascularization in the treatment of patients with cirrhotic portal hypertension might lead to the PVT under some circumstances,and anti-coagulant therapy should be given in time to prevent it happening.