The Application Of Anticoagulant Program After LSED To Prevent PVST

Objective:Through the analysis of liver cirrhosis portal hypertension line of laparoscopic splenectomy in combination with cardiac blood vessels around from broken technique(LSED)postoperative application of low molecular heparin calcium and low molecular heparin calcium + clopidogrel two groups of anticoagulant solution prevention of portal venous system thrombosis(portal vein system thrombosis,PVST)in the comparative study,to discuss low molecular heparin calcium combined clopidogrel prevent LSED postoperative efficacy and safety of portal venous system thrombosis,acquire a new ways of the prevention of postoperative portal vein thrombosis in the clinical medicine.Methods:Were retrospectively analyzed in October 2014 to February 2018,the second affiliated hospital of kunming medical university GanDanYi surgical treated 110 cases of liver cirrhosis portal hypertension,ward three rows of laparoscopic splenectomy in combination with cardiac blood vessels around from broken technique,(LSED)postoperative anticoagulation prevention of portal venous system thrombosis in patients with clinical data.According to the different anticoagulant solution group,experimental group(n = 55):postoperative day 1 to start the application of low molecular heparin calcium 4200 u subcutaneous injection,combined with 75 mg of clopidogrel,Qd*30 days,when patients DD<2 mu g/ml to stop using low molecular heparin calcium,when there is suspicious hemorrhage drainage tube stop using low molecular heparin calcium,if appear suspicious blood clots,via the portal vein abdomen CTA on colour to exceed,and further to determine the type and degree.Found during thrombosis’s immediate line of low molecular heparin calcium 4200 u subcutaneously,twice per day,according to ultrasound or CT review results to decide whether to stop using low molecular heparin calcium,if blood clots by considering the interventional thrombolysis treatment drug therapies;The control group(n = 55):postoperative day 1 to start the application of low molecular heparin calcium 4200 u subcutaneous injection,when patients DD<2 mu g/ml to stop using low molecular heparin calcium,when there is suspicious hemorrhage drainage tube stop using low molecular heparin calcium,if appear suspicious blood clots,via the portal vein colour to exceed,and further the CTA to determine the type and degree of upper abdomen.Found during thrombosis’s immediate line of low molecular heparin calcium 4200 u subcutaneously,twice per day,according to ultrasound or CT review results to decide whether to stop using low molecular heparin calcium,if blood clots by considering the interventional thrombolysis treatment drug therapies.The incidence and type of thrombosis of portal vein in two groups were observed,perioperative period,coagulation function,intraperitoneal hemorrhage and upper gastrointestinal bleeding..Results:The incidence of portal vein thrombosis in the experimental group was 23.6%(13/55),and 2 cases(3.6%),4 cases(7.3%)and 7 cases(12.7%)of the main thrombosis,branch thrombus and splenic vein.In one patient,abdominal hemorrhage occurred during anticoagulant therapy,and the patient was cured and discharged by conservative treatment.The incidence of portal venous thrombosis in the control group was 45.5%(25/55),including 7 cases(12.7%),9 cases(16.4%)and 9 cases(16.4%)respectively.Have 1 patient because of postoperative intraperitoneal hemorrhage,activity hotfoot secondary laparotomy surgery hemostatic,another 3 cases caused by main portal vein thrombosis in patients with upper gastrointestinal bleeding,hospital cured by conservative treatment.The incidence of portal vein thrombosis and main portal vein thrombosis in the experimental group was significantly lower than that in the control group(P=0.008,0.003),and the incidence of upper gastrointestinal bleeding was significantly lower than that of the conventional anticoagulation group(P= 0.048).The maximum blood flow velocity and average blood flow velocity in the experimental group were greater than that in the control group,and the difference was statistically significant(P=0.029),and there was no statistical difference in the diameter of the portal vein in the two groups after treatment(P=0.713).There was no significant difference between the two groups in perioperative and coagulation functions(P value was found in the results),and there was no significant difference in the incidence of intra-abdominal active hemorrhage(P =1.000).Conclusion:1.Laparoscopic splenectomy combined around the cardia from broken blood vessel surgery postoperative use of low molecular heparin calcium ＋clopidogrel compared with the single use of low molecular heparin calcium anticoagulation can significantly reduce the portal venous system thrombosis especially trunk type postoperatively in patients with portal hypertension incidence of thrombosis,reduce the incidence of upper gastrointestinal bleeding again,do not increase the risk of bleeding at the same time,the scheme is safe and feasible.2.The number of two groups of patients with preoperative postoperative platelet(PLT),the blood coagulation function(PT INR,APTT,TT)in the process of dynamic change and treatment of thrombosis or not a huge difference,the influence of the specific impact of thrombosis remains to be further research.3.The correlation between the formation of PVST and platelet count was not high after laparoscopic splenectomy combined with cardiac peripheral blood vessels.4.The experimental group portal vein maximum blood flow velocity,the averageblood flow velocity were greater than the control group,clopidogrel for blood flow velocity of benign role further reduces the incidence of postoperative PVST,but little effect on the diameter of the portal vein before and after the treatment.