The Early Application Of Low Molecular Weigh Heparin In The Prevention Of Portal Venous System Thrombosis After Pericardial Devascularization: A Clinical Study

ObjectiveTo explore the efficacy and security of the early application with low molecularweigh heparin(LMWH) in the prevention of portal venous system thrombosis(PVST)in patients who have undergo splenectomy plus porta-azygous devascularization．Subjects and MethodsWe chosed120patients who needed to have splenectomy plus porta-azygousdevascularization due to portal hypertension (PHT) in Hepatobiliary Surgery of theFirst Affiliated Hospital of Zhengzhou University from June2010to June2013.According to whether treated with LMWH in postoperative anticoagulationtherapy, patients were randomly divided into2groups.Group A(60cases):In the firstday after operation, the patients began to use salvianolate for10days. When platelets >300×109, we use a small dose of aspirin until platelets <300×109. In group B(60cases): On the base of group A s therapy, we add LMWH3200iU to use for10days in the second day after operation. After surgery, all patients were followed uptwo months. Counting and comparing the rate of portal vein system thrombosis(PVST)、the platelet (PLT)、prothrombin time(PT)、activated partial thromboplastintime(APTT) and abdominal drainage fluid yield after surgery in each group.Results1.Patients were followed up for2months,8patients were lost.3cases were lost ingroup A and5cases were lost in group B. The follow-up rate was93%in120patients.112patients were involved in the result analysis,57cases in group A and55cases ingroup B. The preoperative indicators(such as age, sex, liver function, the width of thesplenic vein, portal vein width and PLT count, PT values，APTT values etc.) ofpatients were not significantly different between the group A and B(P>0.05).It wascomparable between the two groups.2.In the two months after surgery,there were21patients forming portal vein systemthrombosis(PVST) in the112patients.The total incidence of PVST was18.75%(21/112).In group A,15cases were formed and the incidence of PVST was26.31%(15/57).10cases were formed PVST during their hospitalization, theincidence of PVST was17.54%(10/55); In group B,6cases were formed and theincidence of PVST was10.91%(6/55);3cases were formed PVST during theirhospitalization, the incidence rate of PVST was5.45%(3/55). The data were analysedwith SPSS13.0software, The incidence of PVST in group B obviously was lowersignificantly than that in group A.3. There were no significant difference in the two groups in PLT count, PT and APTTvalues(P>0.05)..4.The intra-abdominal drainage fluid was no difference between the A and Bgroups.They were not statistically significant (P>0.05).5.During the postoperative anticoagulation therapy time, there were3cases ofpatients with mild hemorrhage symptoms.In group A,there was1patient found black stools symptoms. In group B, there were1patient found black stools symptoms and1patient found subcutaneous hemorrhage. We stopped using anticoagulant drugimmediately when hemorrhage symptoms was found. And then the bloodingsymptom disappeared in all patients.There were no bleeding symptoms in otherpatients.Conclusion1.The early application with LMWH postperatively can reduce the incidence of PSVTin patients who undergo splenectomy with gastroesophageal devascularization. It issafe and effective in clinical application.2.The early postperative application with LMWH will not increase the risk ofpostoperative hemorrhage.