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
ObjectiveTo study the efficacy and safety of early endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy (EST) for patients with acute biliary pancreatitis.Methods420 patients who were admitted to our hospital for management of acute biliary pancreatitis were divided into early endoscopic therapy group (n=218 patients) and conservative therapy group (n=202 patients).The durations for complete disappearance of abdominal pain,decrease in serum and urine amylase levels to normal,liver function recovery time,white blood cell recovery time,and the mean duration and costs of hospitalizations were analyzed.ResultsIn the ERCP group,all patients received EST.The stones in 172 patients with choledocholithiasis were removed with dormia baskets or balloon catheters.In 20 patients with severe acute biliary pancreatitis,endoscopic pancreatic duct stents were inserted for drainage.The durations of complete disappearance of abdominal pain,decrease of serum and urine amylase values to normal,white blood cell recovery time,liver function recovery time,cost of hospitalization and duration of hospitalization were significantly shorter in the early ERCP group than the control group.The mortalities in the ERCP and the control groups were 8.0％ and 22.2％,respectively.Conclusions Early endoscopic management for patients with acute biliary pancreatitis was not only safe and efficacious,but the management helped to identify the underlying causes of pancreatitis and reduced the duration of hospital stay and expenses.