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Objective To explore the effect of early anticoagulation therapy on the blood coagulation in patients undergoing splenectomy plus devascularization.Methods Clinical data of 106 patients in Cangzhou Central Hospital from June 2000 to December 2012 were reviewed.Beginning 24 h after surgery,low molecular dextran 500 ml + ligustrazine 160 mg,once a day for 1 week,and after 48 h low molecular heparin calcium at 4 250 U to 4 500 U was given every 12 h for 7 to 14 d.Blood coagulation was tested on day 3,5,7,10 and 14,ultrasound 1-2 times a week was taken for detection of portal venous thrombosis.Results The incidence of portal thrombosis was 7.5％ (8/106).APTT prolonged during 7-14 d.Prothrombin time (PT),thrombin time (TT) and fibrinogen (FIB) decreased,but all the changes were not statistically significant when compared with the normal values(P ＞0.05).Anticoagulant treatment did not cause bleeding complications in this series.Conclusions Postoperative application of low molecular heparin calcium anticoagulant therapy is effective in the prevention of portal thrombosis and safe in terms of coagulation when started early in patients undergoing splenectomy.
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Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome.
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ObjectiveTo evaluate the effect of early anticoagulation therapy in the prevention of portal venous system thrombosis (PVT) in portal hypertensive patients undergoing splenectomy plus portaazygous devascularization. MethodsAt our hospital from August 1994 to July 2011,157 patients underwent splenectomy plus devascularization. Among them 89 cases (beginning 2000 )receiving intravenous low molecular dextran 500 ml daily for 7 days starting immediately postoperatively,and after 48 h subcutaneously low molecular weight heparin calcium 4250 U every 12 hours for 7 - 14 d were in group A.Before 2000,the 68 cases receiving no postoperative anticoagulation therapy were in the control group (B).After 3 - 12 months follow-up,PVT was evaluated and compared between the two groups. ResultsIn group A thrombosis incidence was 8％ (7/89),of which class Ⅰ, Ⅱ thrombosis accounted for 71％(5/7),class Ⅲ and up thrombosis accounted for 29％ (2/7),there was no bowel necrosis case; In group B thrombosis incidence was 29％ (20/68),class Ⅰ,Ⅱ thrombosis accounted for 20％ (4/20),class Ⅲand above thrombosis accounted for 80％ (16/20),3 cases suffered from intestinal necrosis,the difference was statistically significant (P ＜ 0.01 ). ConclusionsMultifactors lead to postoperative PVT formation,early postoperative,anticoagulation therapy is safe,and effective in the prevention of postoperative PVT.
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Objective To study the efficacy of surgical treatment in hilar cholangiocarcinoma patients. Methods One hundred and four cases underwent surgical treatment of hilar cholangiocarcinoma were retrospective enrolled in the study from 1998 to 2008, including 45 cases of radical resection, 38 cases of palliative resection, vitro bridge drainage in 21 cases, 93 cases of postoperative patients. Ninty-three patients were followed up for 5 - 67 months, the different procedures of the treatment was summerized. Results Oneyear survival rate of radical resection and palliative resection was 80. 0% ( 32/40 ) and 86. 8% ( 33/38 ),respectively. No significant difference between the two groups (P ＞0. 01 ) were found; 2-year survival rate was 67. 5% (27/40) and 39. 5% ( 15/38), with significant difference between the two groups (P ＜0. 01 ) ;3-year survival rates were 37.5% ( 15/40 ) and 13.2% ( 5/38 ), with significant difference between the two groups (P＜0. 05). Palliative resection had higher 1-year survival rate than in vitro bridge drainage(P ＜ 0.01).Conclusion Surgical treatment of hilar cholangiocarcinoma is the most effective way to prolong the survival time of radical resection, radical surgery had better efficacy than palliative surgery, and palliative surgery is superior to external drainage. In patients of severe jaundice combined with biliary drainage infection, preoperative bridge drainage would improve the safety.