脾切除联合食管胃底曲张静脉断流术后应用华法林对门静脉血栓的防治作用

doi:10.3969/j.issn.1672-5069.2019.02.022

实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (2): 240-243.doi: 10.3969/j.issn.1672-5069.2019.02.022

脾切除联合食管胃底曲张静脉断流术后应用华法林对门静脉血栓的防治作用

赵晓飞,林栋栋,李宁,臧运金,郭庆良,武聚山

100069 北京市首都医科大学附属北京佑安医院普外科/肝移植中心

收稿日期:2018-04-16 出版日期:2019-03-10 发布日期:2019-03-19
通讯作者: 林栋栋,E-mail:ldd1231@sohu.com
作者简介:赵晓飞,男,35岁,硕士研究生,主治医师。主要从事肝硬化、肝脏肿瘤和肝移植治疗研究。E-mail:bluer7741@sina.com

Application of warfarin in dealing with portal vein thrombosis in patients with liver cirrhosis after splenectomy and devascularization

Zhao Xiaofei, Lin Dongdong, Li Ning, Zang Yunjin, Guo Qingliang, Wu Juanshan

Department of General Surgery and Liver Transplantation Center,You’an Hospital Affiliated to Capital Medical University,Beijing 100069,China

Received:2018-04-16 Online:2019-03-10 Published:2019-03-19

摘要/Abstract

摘要： 目的探讨脾切除联合食管胃底曲张静脉断流术后应用华法林对门静脉血栓的防治效果。方法 2010年4月~2015年9月收治的48例门静脉血栓（PVT）患者,在行脾切除联合食管胃底曲张静脉断流术后,对25例患者短期应用华法林治疗1个月,23例患者应用华法林6个月,常规行彩色多普勒超声检查判断门静脉血栓变化。随访比较两组门静脉血栓变化和预后情况。结果随访2年,48例术前存在PVT患者在脾切除联合断流术后,PVT进展20例（41.7%）,其中长期应用华法林组6例（26.1%）,显著低于短期应用华法林组的14例（56.0%,P<0.05）;PVT显著进展11例（22.9%）,其中长期应用华法林组2例（8.7%）,也显著低于短期应用华法林组的9例（36.0%,P<0.05）;短期应用华法林组PVT再通、再出血、肝癌和死亡发生率分别为0.0%、4.0%、8.0%和4.0%,与长期应用华法林组（分别为4.3%、4.3%、4.3%和0.0%）比,无显著性差异（P>0.05）。结论在脾切除联合食管胃底曲张静脉断流术后应用华法林防治门静脉系统血栓安全、有效,可使患者获益。

关键词: 肝硬化, 门静脉血栓, 脾切除联合食管胃底曲张静脉断流术, 华法林, 防治

Abstract: Objective To investigate the application of warfarin in dealing with portal vein thrombosis （PVT） in patients with liver cirrhosis after splenectomy and devascularization. Methods A retrospective analysis of the clinical data was made in 48 patients with cirrhosis and PVT after plenectomy and devascularization between April 2010 and September 2015 in Beijing You’an Hospital. 25 patients took warfarin for 1 months and 3 patients took warfarin for 6 months after the operation. The changes of PVT after splenectomy and devascularization was compared between the two groups according to the US examination. Results Out of the 48 patients with PVT,the PVT progressed in 20 cases （41.7%）,and 6 cases（26.1%） of them was from patients who took warfarin for 6 months,and 14 （56%） was from patients who took warfarin for one month （P<0.05）;the PVT significantly progressed in 11 cases（22.9%）,including 9 cases（36%） in patients taking warfarin for one month and 2 cases（8.7%） in patients taking warfarin for 6 months（P=0.039）;the incidences of repatency of PVT, rebleeding,liver cancer and death in patients taking warfarin shortly were 0.0%,4.0%,8.0% and 4.0%,no significantly different as compared to 4.3%,4.3%,4.3% and 0.0%（P>0.05） in patients taking warfarin for six months. Conclusion The application of warfarin in dealing with portal vein thrombosis（PVT） in patients with liver cirrhosis after splenectomy and devascularization is safe and effective,which might stop the progress of PVT and decrease the risk of rebleeding.

Key words: Liver cirrhosis, Portal vein thrombosis, Splenectomy, Devascularization, Warfarin, Prophylaxis and treatment

赵晓飞,林栋栋,李宁,臧运金,郭庆良,武聚山. 脾切除联合食管胃底曲张静脉断流术后应用华法林对门静脉血栓的防治作用[J]. 实用肝脏病杂志, 2019, 22(2): 240-243.

Zhao Xiaofei, Lin Dongdong, Li Ning, Zang Yunjin, Guo Qingliang, Wu Juanshan. Application of warfarin in dealing with portal vein thrombosis in patients with liver cirrhosis after splenectomy and devascularization[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(2): 240-243.

参考文献

[1] Delatour HB. Thrombosis of the mesenteric veins as a cause of death after splenectomy. Ann Surg,1895,21:24-28.
[2] Wu CC,Cheng S,Ho WM.Appraisal of concomitant splenectomy in liver resection for hepatocellular carcinoma in cirrhotic patients with hypersplenic thrombocytopenia. Surgery,2004,136:660-668.
[3] Naeshiro N,Aikata H,Hyogo H,et al.Efficacy and safety of the anticoagulant drug,danaparoid sodium,in the treatment of portal vein thrombosis in patients with liver cirrhosis. Hepatol Res,2015,45(6):656-662.
[4] Charco R,Fuster J,Fondevila C,et al.Portal vein thrombosis in liver transplantation. Transplant Proc,2005,37:3904-3905.
[5] Kalambokis GN,Oikonomou A,Christou L,et al.High von Willebrand factor antigen levels and procoagulant imbalance may be involved in both increasing severity of cirrhosis and portal vein thrombosis. Hepatology,2016,64:1383-1385.
[6] Li MX,Zhang XF,Liu ZW,et al.Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis. Hepatobiliary Pancreat,2013,12:512-519.
[7] Zocco MA,Di Stasio E,De Cristofaro R,et al.Thrombotic risk factors in patients with liver cirrhosis:correlation with MELD scoring system and portal vein thrombosis development. Hepatology,2009,51:682-689.
[8] Abdel-Razik A,Mousa N,Elhelaly R,et al.De-novo portal vein thrombosis in liver cirrhosis: risk factors and correlation with the model for end-stage liver disease scoring system. Hepatology,2015,27:585-592.
[9] Chen H,Trilok G,Wang F,et al.A single hospital study on portal vein thrombosis in cirrhotic patients-clinical characteristics & risk factors. Indian J Med Res,2014,139:260-266.
[10] Maruyama H,Okugawa H,Takahashi M,et al.De novo portal vein thrombosis in virus-related cirrhosis:predictive factors and long-term outcomes. Gastroenterology,2013,108:568-574.
[11] Sun LC,Zhou H.Effects of surgical procedures on the occurrence and development of postoperative portal vein thrombosis in patients with cirrhosis complicated by portal hypertension. Int J Surg,2015,16:31-35.
[12] 李玲,陈世耀. 从Virchow三要素分析肝硬化患者发生门静脉血栓危险因素. 实用肝脏病杂志,2015,18(3):325-328.
[13] Wu SL,Wu Z,Zhang XG,et al.The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization. Turk J Gastroenterol,2015,26:423-428.
[14] 潘澄,史源,张建军,等. 门静脉血栓的肝移植术中处理. 中华器官移植杂志,2009,30(3):164-166.
[15] 汤照峰,邓美海,凌云彪,等. 早期抗凝、祛聚预防门静脉高压症脾切除术后门静脉血栓形成.中华肝胆外科杂志,2008,14(2):85-87.
[16] Rattner DW,Ellman L,Warshaw AL.Portal vein thrombosis after elective splenectomy. An underappreciated,potentially lethal syndrome. Arch Surg,1993,128:565-570.
[17] Senzolo M,Sartori MT,Rossetto V,et al.Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int,2012,32(6):919-927.
[18] Delgado MG,Seijo S,Yepes I,et al.Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol,2012,10(7):776-783.
[19] Amitrano L,Guardascione MA,Menchise A,et al.Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. Clin Gastroenterol,2010,44(6):448-451.
[20] Werner KT,Sando S,Carey EJ,et al.Portal vein thrombosis in patients with end stage liver disease awaiting liver transplantation:outcome of anticoagulation. Dig Dis Sci,2013,58(6):1776-1780.

脾切除联合食管胃底曲张静脉断流术后应用华法林对门静脉血栓的防治作用

Application of warfarin in dealing with portal vein thrombosis in patients with liver cirrhosis after splenectomy and devascularization

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈帅, 杨长青. 门静脉血栓病因及危险因素研究进展^*[J]. 实用肝脏病杂志, 2019, 22(6): 761-764.
[2]	庄莹, 林志辉. 肝硬化并发门静脉血栓临床表现和诊断进展[J]. 实用肝脏病杂志, 2019, 22(6): 765-767.
[3]	鲍应军, 任伟新. 门静脉血栓介入治疗研究进展[J]. 实用肝脏病杂志, 2019, 22(6): 768-769.
[4]	杨才勇, 陈娜, 李奎, 江自成, 卜蓉蓉. 慢性丙型肝炎和丙型肝炎肝硬化患者外周血Treg和Th17水平变化临床意义探讨^*[J]. 实用肝脏病杂志, 2019, 22(6): 868-871.
[5]	朱娅鸽, 刘锦峰. 丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化患者疗效及其对血清BGP水平的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 872-875.
[6]	武丹, 马向鹰. 非酒精性脂肪性肝病肝硬化患者胰岛素抵抗水平与颈动脉硬化程度和左心室功能研究^*[J]. 实用肝脏病杂志, 2019, 22(6): 876-879.
[7]	陈梅梅, 段晓燕, 曹海霞, 丁雯瑾. 复方鳖甲软肝片治疗原发性胆汁性肝硬化患者疗效分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 880-883.
[8]	刘李, 杨烈, 陈海洋, 何承俊, 王建宇, 陈廷昊. 肝硬化门静脉高压症并发脾动脉盗血综合征患者脾切除联合贲门周围血管离断术后门脉血流动力学的变化^*[J]. 实用肝脏病杂志, 2019, 22(6): 884-887.
[9]	何志安, 余丽萍, 赖江琼, 黄思付. ARFI评估肝硬化并发食管胃底静脉曲张患者出血和门静脉血栓的价值分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 888-891.
[10]	王月圆, 王燕, 张丹丹. 奥曲肽辅助特利加压素治疗失代偿期肝硬化并发肝肾综合征患者疗效分析*[J]. 实用肝脏病杂志, 2019, 22(5): 684-687.
[11]	张梅, 石秀英, 李林娟, 薛亚妮. 肝源性糖尿病患者肝组织干扰素诱导蛋白-10表达变化*[J]. 实用肝脏病杂志, 2019, 22(5): 688-691.
[12]	丹珠永吉, 刘芝兰, 禄艳艳, 蒋汉梅. 内镜下序贯套扎和硬化剂治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效及对血流动力学的影响对比研究*[J]. 实用肝脏病杂志, 2019, 22(5): 692-695.
[13]	黄汉军, 鲁凤荣, 张灿. 基于Exchange血流动力学模型的MRI扫描参数诊断肝硬化临床价值分析*[J]. 实用肝脏病杂志, 2019, 22(5): 696-699.
[14]	赵芳芳, 翟永贞, 冯国和. 自体外周血干细胞移植治疗乙型肝炎肝硬化患者疗效及安全性分析[J]. 实用肝脏病杂志, 2019, 22(5): 700-703.
[15]	陈山, 庄华帅, 邢诒喜, 吴直佳. 美罗培南治疗肝硬化并发上消化道出血患者对感染预防和再出血的影响*[J]. 实用肝脏病杂志, 2019, 22(5): 704-707.