【作者】 葛颂；

【导师】 严盛；

【作者基本信息】 浙江大学 ， 外科学（专业学位）， 2015， 硕士

【摘要】 目的：探索腹腔镜脾切断流术(LSED)后早期预防性应用低分子肝素(LMWH)对于预防术后门静脉血栓(PVST)形成的疗效及安全性。方法：回顾性分析浙江大学附属第一医院肝胆胰外科自2012年1月至2015年1月因患肝硬化门脉高压症行腹腔镜脾切断流术的患者,其中符合标准并有完整病例资料的患者共41例,入院完善患者一般资料及各项相关检查,将患者肝功能调整至Child-Pugh分级B级以上,并实施LSED手术,根据患者术后是否早期预防性应用低分子肝素抗凝治疗分为试验组(LMWH组)及对照组：LMWH组患者25例,其中男性19例,女性6例；对照组16例,其中男性10例,女性6例。术后定期复查患者肝功能及凝血指标,并常规于术后第1天、出院前及术后2个月行彩超检查,以明确有无PVST形成。出现门静脉系统的血栓,无论在脾静脉、肠系膜上静脉、肠系膜下静脉或门静脉主干任意处部分或完全性附壁血栓,均可诊断为PVST.应用SPSS20.0软件包进行统计学分析,计量资料以x±s表示,两组间比较采用独立样本t检验；两组间分类计数资料采用χ2检验或χ2检验的连续性校正进行数据分析,以P<0.05为差异有统计学意义。结果：对照组与LMWH组比较性别、年龄等一般情况,手术前及术后肝功能、凝血指标无明显差异(P>0.05)。两组患者在院期间,对照组术后PVST发生率为56.25%,LMWH组术后PVST发生率为12%,两组患者在住院期间发生的PVST的概率的差异显著,具有统计学意义(P<0.05)；LMWH组未出现出血等与低分子肝素使用相关的并发症；术后2个月进行复查彩超检查,对照组患者PVST发生率为68.75%,LMWH组患者发生PVST发生率为16%,两组患者在术后2个月内发生PVST的概率的差异显著,具有统计学意义(P<0.05)。结论：腹腔镜脾切断流术后早期预防性行低分子肝素抗凝治疗可安全有效地预防门静脉血栓形成,并不会增加患者术后出血等并发症的风险。更多还原

【Abstract】 Objective:To investigate the curative effect and security of low molecular weight heparin in preventing postoperative portal vein system thrombosis after laparoscopic splenectomy with esophagogastric devascularization.Methods:The clinical data of patients with portal hypertension receiving laparoscopic splenectomy with esophagogastric devascularization in the first affiliated hospital of Zhejiang university from January2012to January2015were analyzed retrospectively. Of which41cases of patients with complete clinical data were conformed to the standards. According to whether with postoperative early application of low molecular heparin, patients were divided into experimental group and control group. The postoperative liver function and coagulation indexes of patients were periodic reexamination and color doppler ultrasound was performed at the1st day after the operation and the day before hospital discharge and two months after the operation respectively to know thrombosis of portal vein. Any partial or complete mural thrombus in the splenic vein and superior mesenteric vein, inferior mesenteric vein and portal vein trunk can be diagnosed as PVST. Statistical analysis was done by SPSS20.0software. Continuous variables were expressed as (x±s), which was analyzed by student’s t-test between two groups; Categorical variables was analyzed by chi-square test, and there was significantly difference when P<0.05.Results:There are no obvious difference (P>0.05) between control group and LMWH groups in gender, age, general situation, preoperative and postoperative liver function and blood coagulation indexs. At the time of hospitalization, the incidence of postoperative PVST was56.25%in the control group and12%in the LMWH group, of which the difference between two groups was statistically significant (P<0.05). Two months after the operation, the incidence of postoperative PVST was68.75%in the control group and16%in the LMWH group, of which the difference between two groups was statistically significant (P<0.05).Conclusion:The early preventive systemic application of LMWH is effective in preventing PVST after LSED, and does not increase the morbidity risk.更多还原