门静脉高压症脾切断流术后门静脉血栓的防治

门静脉高压症脾切断流术后门静脉血栓的防治

摘要】目的：观察门静脉高压症行脾切除术后早期接受低分子肝素联合华法林

等抗凝治疗预防门静脉血栓的临床效果。方法：收集60例行脾切断流术的门静

脉高压症患者，随机分为对照组与实验组，每组各30 例。对照组服用常规剂量

阿司匹林治疗，实验组则于术后早期接受低分子肝素联合华法林治疗，就两组术

后血小板（PLT）计数的变化及门静脉血栓的发生率施以对比。结果：患者术后PLT 计数均有所升高，但在不同时间点两组比较无显著差异（P＞0.05）；实验组

的门静脉血栓发生率为6.67%，显著低于对照组的36.67%，组间比较差异有统计

学意义（P＜0.05）。结论：门静脉高压症脾切断流术患者术后早期行低分子肝素

联合华法林抗凝治疗能有效预防门静脉血栓的形成，是一种较为安全、有效的治

疗方案。

【关键词】门静脉高压症；脾切断流术；门静脉血栓【中图分类号】

R657.3+4【文献标识码】A【文章编号】1276-7808（2015）-03-001-02Portal hypertension splenectomy of portal vein thrombosis prevention devascularizationZhang XiaojianDepartment of general surgery of Shangqiu First People's Hospital a Henan Shangqiu 476100【Abstract】Objective：To observe the effect of portal hypertension splenectomy after early acceptance of low molecular weight heparin combinedwith Hua Falin anticoagulation clinic effect in the prevention

of portal vein thrombosis.Methods：to collect 60 cases underwent splenectomy anddevascularization in portal hypertension patients，were randomly divided into control group and experimental group，30 cases in each group.The controlgroup was given conventional dose aspirin treatment，experimental group in the early acceptance of low molecular weight heparin combined with HuaFalin after surgical treatment，the two groups of postoperative changes of platelet （PLT）and portal vein thrombosis incidence to contrast the count.Results：the PLT count were increased in patients with postoperative，but at different time points between the

two groups had no significant difference（P > 0.05）；portal vein thrombosis in experimental group the incidence rate was 6.67%，significantly lower than the 36.67% in the control group，there werestatistically significant differences between groups

（P < 0.05）.Conclusion：portal hypertension splenectomy and devascularization in patients with earlypostoperative period of low molecular heparin and warfarin anticoagulation therapy can prevent the formation of thrombus in portal vein，which

is a safe，effective treatment scheme.【Key words】portal hypertension；splenectomy and devascularization；portal vein thrombosis门静脉高压症是多由肝

硬变引起的门脉血流动力学异常的临床综合征，其中食管及胃底静脉曲张破裂出

血为本病较为严重的并发症，经数据统计显示约70%的肝硬变患者会出现上消化

道出血，亦是导致患者死亡的主要原因[1]。脾切除、贲门周围血管离断术（断流术）是目前临床上较为推崇的治疗门静脉高压症的手术方法，门静脉血栓形成为

该手术后的常见并发症，因临床表现缺乏特异性，极易出现漏诊，且病情发展快、病死率高[2]。因此，门静脉高压症行脾切除术后预防门静脉血栓形成具有十分重

要的意义。本次研究旨在观察低分子肝素联合华法林等抗凝治疗预防门静脉高压

症行脾切除术后门静脉血栓形成的临床效果，成绩满意。具体报告如下：1 资料

与方法1.1 一般资料本次研究观察对象均遴选于2011 年01 月-2013 年12 月我院

确诊并收治的行脾切断流术的门静脉高压症患者，共60 例。病例均参照中华医