早期抗凝干预用于经颈静脉肝内门体静脉支架分流术联合PSE治疗肝硬化患者价值探讨*

目的 研究在经颈静脉肝内门体静脉支架分流术(TIPS)联合部分脾栓塞(PSE)术治疗的肝硬化并发食管胃底静脉曲张患者早期抗凝干预对预防门静脉血栓形成的价值。方法 2016年9月～2018年9月我院收治的86例肝硬化并发门静脉高压症患者,均接受TIPS联合PSE治疗。术后,采用抽签法随机将患者分为对照组43例,给予肝素和阿司匹林抗凝治疗,和观察组43例,术后给予低分子肝素联合华法林治疗。随访3个月。结果 术后7 d,观察组PLT为(274.3±30.2)×10⁹/L,显著高于术前,对照组PLT为(257.6±29.7)×10⁹/L,也显著高于术前;观察组PLT、PT和APTT与对照组比较差异均无统计学意义(P＞0.05);门静脉直径为(12.2±2.2)mm,门静脉血流流速为(12.6±2.3)cm/s,门静脉血流量为(910.6±260.2)ml/min,与对照组的(12.1±2.0)mm、(13.0±4.1)cm/s和(889.4±192.6)ml/min比,差异无统计学意义(P>0.05);两组腹水、出血、肝性脑病、皮肤瘀斑和发热发生率比较差异均无统计学意义(P＞0.05),但观察组门静脉血栓形成发生率为2.3%,显著低于对照组的16.3%(P＜0.05)。结论 早期给予低分子肝素联合华法林抗凝处理能有效预防TIPS联合PSE术后门静脉系统血栓形成,临床应引起足够的重视。

Value of early anticoagulant intervention in cirrhotic patients with portal hypertension after transjugular intrahepatic portosystemic stent shunt combined with PSE

Objective The aim of this study was to investigate the value of early anticoagulant intervention in cirrhotic patients with portal hypertension after transjugular intrahepatic portosystemic stent shunt(TIPS)combined withpartial splenic embolism(PSE).Methods 86 patients with cirrhosis and portal hypertension were recruited in our hospital between September 2016 and September 2018,and were randomly divided into two groups.All patients underwent TIPS and PSE,and after operation,the patients were divided into two groups.The patients in control received heparin and aspirin,and those in the observation received low molecular weight heparin combined with warfarin for anticoagulant intervention.All patients were followed-up for three months.Results The platelet count in the observation group was(274.3±30.2)×10^9/L on the 7th day after operation,which was significantly higher than[(58.0±20.1)×10^9/L,P<0.05]before operation,and PLT count in the control group was(257.6±29.7)×10^9/L,which was also significantly higher than[(61.0±24.4)×10^9/L,P<0.05]before operation;there were no significant differences as respect to PLT counts,prothrombin time(PT)and activated partial thrombin activity time(APTT)between the two groups(P>0.05);On the 7th day after surgery,there were no significant differences as respect to the diameter of portal vein,the average blood velocity of portal vein and the portal vein flow between the two groups(P<0.05);there was no significant difference in the incidence of ascites,hemorrhage,hepatic encephalopathy,skin ecchymosis and fever between the two groups(P>0.05),while the incidence of portal thrombosis in the observation group was 2.5%,significantly lower than 16.7%in the control(P<0.05).Conclusion Early intervention with low molecular weight heparin combined with warfarin might effectively prevent portal vein thrombosis after TIPS combined with PSE in patients with cirrhosis,which warrants further investigation.