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*

doi:10.3969/j.issn.1672-5069.2020.01.023

摘要/Abstract

摘要： 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。

关键词: 肝硬化, 门脉高压症, 经颈静脉肝内门体静脉支架分流术, 部分脾栓塞, 肝素

Abstract: 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)×10⁹/L on the 7th day after operation, which was significantly higher than before operation, and PLT count in the control group was (257.6±29.7)×10⁹/L, which was also significantly higher than 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.

Key words: Liver cirrhosis, Transjugular intrahepatic portosystemic stent shunt, Partial splenic embolism, Heparin

赵平, 黎涛, 谢吉良, 郑波. 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^*[J]. 实用肝脏病杂志, 2020, 23(1): 82-85.

Zhao Ping, Li Tao, Xie Jiliang, et al. Value of early anticoagulant intervention in cirrhotic patients with portal hypertension after transjugular intrahepatic portosystemic stent shunt combined with PSE[J]. Journal of Practical Hepatology, 2020, 23(1): 82-85.

参考文献

[1] Bissonnette J, Carlos Garcia-Pagán J, Albillos A, et al. Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension. Hepatology, 2016, 64(1):224-231.
[2] Qi X, He C, Guo W, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis: outcomes and predictors in a prospective cohort study. Liver Int, 2016, 36(5):667-676.
[3] Wang Z, Jiang MS, Zhang HL, etal. Is post-TIPS anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? a randomized controlled trial. Radiology, 2016, 279(3):943-951.
[4] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.酒精性肝病防治指南(2018年更新版).实用肝脏病杂志,2018,21(2): 170-176.
[5] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):Ⅴ-ⅩⅩⅢ.
[6] 中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[7] 游玉峰, 谭必勇, 何小俊, 等. PTIPS治疗脾切除术后并发门静脉血栓形成的门静脉高压症患者安全性和效果分析. 实用肝脏病杂志, 2018, 21(3):372-375.
[8] Lahat E, Lim C, Bhangui P, et al. Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review. Hpb, 2018,20(2):101-109.
[9] Valentin N, Korrapati P, Constantino J, et al. The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis. Eur J Gastroen Hepat, 2018, 30(10):1187-1193.
[10] Busk TM,Bendtsen F, Henriksen JH, et al. Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis. J Hepatol, 2016, 64(2):S453-S453.
[11] Kato A,Shimizu H, Ohtsuka M, et al. Portal vein stent placement for the treatment of postoperative portal vein stenosis: long-term success and factor associated with stent failure. Bmc Surg, 2017, 17(1):11-16.
[12] Qi X, De Stefano V, Guo X . Quality of anticoagulation and outcome of bleeding in cirrhosis. Hepatology, 2016, 64(1):320-321.
[13] Gottardi AD, Trebicka J, Klinger C, et al. Antithrombotic treatment with direct-acting oral anticoagulants (DOACs) in patients with splanchnic vein thrombosis and cirrhosis. Liver Int, 2016, 37(5):694-699.
[14] Cui SB, Shu RH, Yan SP, et al.Efficacy and safety of anticoagulation therapy with different doses of enoxaparin for portal vein thrombosis in cirrhotic patients with hepatitis B. Eur J Gastroenterol Hepat, 2015, 27(8):914-919.
[15] Loffredo L, Pastori D, Farcomeni A, et al. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis:a systematic review and meta-analysis. Gastroenterology, 2017, 153(2):480-487.
[16] Bechmann LP, Sichau M, Wichert M, et al. Low-molecular-weight heparin in patients with advanced cirrhosis. Liver Int, 2015, 31(1):75-82.
[17] Helgason CM, Grossi E, Pandey D, et al. Platelet aggregation and recruitment with aspirin-clopidogrel therapy. Cerebrovasc Dis, 2015, 25(5):392-400.
[18] Ohnuki Y, Ohnuki Y, Kohara S, et al. Dual therapy with aspirin and cilostazol may improve platelet aggregation in noncardioembolic stroke patients: a pilot study. Internal Med, 2017, 56(11):1307-1313.
[19] Wu C, Alotaibi GS, Alsaleh K, et al. Case-fatality of recurrent venous thromboembolism and major bleeding associated with aspirin, warfarin, and direct oral anticoagulants for secondary prevention. Thromb Res, 2015, 135(2):243-248.
[20] Afshari D, Moradian N, Nasiri F, et al. The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis. Neurosciences, 2015, 20(4):357-361.

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^*

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

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]	徐小元. 解读肝硬化诊治指南难点与新颖之处[J]. 实用肝脏病杂志, 2020, 23(1): 4-6.
[2]	杨晓玲, 张素梅. SGA、MNA和NRS2002评估失代偿期肝硬化患者营养状态应用价值分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 70-73.
[3]	王晶晶, 李春涛, 周卫真. 失代偿期乙型肝炎肝硬化患者尿液视黄醇结合蛋白水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2020, 23(1): 74-77.
[4]	杨慧玲, 刘小静, 何英利, 杜粉静, 叶峰. 失代偿期乙型肝炎肝硬化患者发生医院感染临床特点及危险因素分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 78-81.
[5]	张冰, 解学军. 酒精性肝硬化患者血CTLA-4和PNPLA3基因多态性及其临床意义分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 86-89.
[6]	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.
[7]	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.
[8]	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.
[9]	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.
[10]	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.
[11]	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.
[12]	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.
[13]	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.
[14]	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.
[15]	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.