ABSTRACT
Objective:To investigate the preventive effect and safety of prophylactic anticoagulant therapy with different doses on portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization.Methods:109 hospitalized patients with portal hypertension undergoing laparoscopic procedures were divided into non preventive anticoagulant group(36 case), low dose prophylactic anticoagulant group(39 case), high dose preventive anticoagulant group(34 case). the incidence of portal vein thrombosis, the Yerdel greading, platelet count, APTT and bleeding complications were observed.Results:The incidence of portal vein thrombosis was 75%(27 cases), 49%(19 cases) and 29%(10 cases)respectively, (χ 2=14.719, P=0.001). There was no statistically significant difference among groups of postoperative platelet count[(569±46)×10 9/L, (565±42) ×10 9/L, (536±45)×10 9/L, F=0.074, P=0.909]; The level of D-dimer in the non-prophylactic anticoagulation group was significantly higher than that in the prophylactic anticoagulation groups[(6.35±1.24) mg/L, (2.97±0.48) mg/L, (2.13±0.38) mg/L, F=7.85, P=0.002]; The postoperative PT prolongation time in the prophylactic anticoagulation groups was longer than that in the non-prophylactic anticoagulation group[(18.5±0.7)s, (17.4±0.6)s, (12.7±0.2)s, F=30.88, P<0.001]. Conclusion:High dose prophylactic anticoagulation therapy can effectively reduce the incidence of portal vein thrombosis after laparoscopic splenectomy combined with pericardia devascularization without increasing the risk of postoperative bleeding.
ABSTRACT
Objective To investigate the efficacy and safety of preventive anticoagulant therapy at different time windows on formation of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization.Methods The study was performed as a randomized,prospective trial.83 patients with portal hypertension who underwent laparoscopic splenectomy and pericardial devascularization were divided into four groups:the non preventive anticoagulant group (n =21),the prophylactic anticoagulant group (n =23),the 24 hours of preventive anticoagulant group (n =19) and the 48 hours of preventive anticoagulant group (n =20).The incidences of postoperative portal vein thrombosis,the Yerdel grading,platelet count,APTT,and bleeding complications were studied.Results The incidences of portal vein thrombosis in the four groups were 100％,39.1％,47.3％,55％,respectively,and the difference among the 4 groups was significantly different (P ＜ 0.05).The incidences of portal vein thrombosis between the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group showed no significant difference (P ＞0.05),but the incidences of portal vein thrombosis after 48 hours of preventive anticoagulant group was significantly higher than the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group,respectively (P ＜ 0.05).Postoperative bleeding complications,platelet count and APTT after the operations showed no significant differences (P ＞ 0.05).However,the plasma level of D-dimer in the non preventive anticoagulant group was significantly higher than the preventive anticoagulant group (P ＜ 0.05).Conclusion Preventive anticoagulant therapy effectively reduced the incidence of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization,but it did not significantly increase the risk of postoperative bleeding complications.