术后早期应用低分子肝素对胃肠道恶性肿瘤术后深静脉血栓形成的影响_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 胡殿贺 ¹ , 韩亚东 ² ,  侍阳 ² , 朱孝成 ²

1. ;
2. ;

Corresponding author：

侍阳, Email: shiyang999@126.com

Keywords：

胃肠道恶性肿瘤; 低分子肝素; 深静脉血栓; 预防

DOI：

10.7507/1007-9424.20160129

Video：

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目的探讨术后早期应用低分子肝素（LMWH）对预防胃肠道恶性肿瘤患者术后下肢深静脉血栓（DVT）形成的安全性和有效性。方法将2014年7月至2015年7月期间徐州医学院附属医院普外科收治的92例胃肠道恶性肿瘤患者随机分为2组，即住院号末尾数为奇数者纳入低分子肝素组，偶数者纳入对照组，最终低分子肝素组47例、对照组45例。低分子肝素组于术后12～24 h开始于腹部皮下注射依诺肝素4 000 U，1次/d，用至术后第7天；对照组未采取预防性用药。术后第7天清晨抽取静脉血检测凝血功能、D-二聚体（DD）及血小板（PLT）指标；记录患者术后7 d内腹腔引流量，评价安全性；术后1周复查双下肢深静脉彩超，比较2组DVT发生率。结果 2组患者一般资料比较其差异无统计学意义，具有可比性（P＞0.05）。术后第7天2组患者的凝血酶源时间（PT）、活化部分凝血酶时间（APTT）及PLT相比差异无统计学意义（P＞0.05）；低分子肝素组术后第7天纤维蛋白原（FIB）及DD明显低于对照组，差异有统计学意义（P＜0.05）。2组患者术后7 d内腹腔引流量差异无统计学意义（P＞0.05）；2组患者术后下肢DVT发生率差异有统计学意义，对照组高于低分子肝素组（P＜0.05）。结论术后早期应用低分子肝素可有效降低胃肠道恶性肿瘤患者术后下肢DVT形成，且不增加出血风险。

Citation： 胡殿贺, 韩亚东, 侍阳, 朱孝成. 术后早期应用低分子肝素对胃肠道恶性肿瘤术后深静脉血栓形成的影响. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 487-489. doi: 10.7507/1007-9424.20160129 Copy

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2.	Cheung HY, Chung CC, Yau KK, et al. Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in Chinese patients.Asian J Surg, 2008, 31(2):63-68.
3.	Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation, 2003, 107(23 Suppl 1):I9-I16.
4.	Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer:American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013, 31(17):2189-2204.
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8.	Vaitkus PT, Leizorovicz A, Cohen AT, et al. Mortality rates andrisk factors for asymptomatic deep vein thrombosis in medical patients. Thromb Haemost, 2005, 93(1):76-79.
9.	Saxena A, Mittal A, Arya SK, et al. Safety and efficacy of low-molecular-weight heparins in prophylaxis of deep vein thrombosis in postoperative/ICU patients:A comparative study. J Nat Sci Biol Med, 2013, 4(1):197-200.
10.	Mismetti P, Laporte S, Darmon JY, et al. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolismin general surgery. Br J Surg, 2001, 88 (7):913-930.
11.	陶国全, 葛恒发, 姜宝飞, 等.腹腔镜结直肠术后并发症的处理.中华消化外科杂志, 2011, 10(1):47-47.
12.	叶华, 陈平, 郑祺, 等.胃癌术后早期应用低分子肝素对静脉血栓形成的影响.中华普通外科杂志, 2014, 29(011):875-876.
13.	纪烈辰, 俞林.直肠癌术后应用低分子肝素预防静脉血栓性疾病的价值.中华消化外科杂志, 2013, 12(6):428-430.
14.	Fanikos J, Piazza G, Zayaruzny M, et al. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost, 2009, 102(4):688-693.
15.	Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med, 2006, 355 (17):1780-1789.
16.	邵新宏, 包文.下肢深静脉血栓手术与溶栓治疗效果的比较.中国普外基础与临杂志, 2011, 18(12):1309-1313.
17.	马志强, 魏松洋, 杨瑞丽, 等.下肢深静脉血栓形成的治疗经验.中国普外基础与临床杂志, 2011, 18(2):202-203.

1. Büller HR, Prins MH, Lensing AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366(14):1287-1297.
2. Cheung HY, Chung CC, Yau KK, et al. Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in Chinese patients.Asian J Surg, 2008, 31(2):63-68.
3. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation, 2003, 107(23 Suppl 1):I9-I16.
4. Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer:American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013, 31(17):2189-2204.
5. Smith BR, Diniz S, Stamos M, et al. Deep venous thrombosis after general surgical operations at a university hospital:two-year data from the ACS NSQIP. Arch Surg, 2011, 146(12):1424-1427.
6. Laryea J, Champagne B. Venous thromboembolism prophylaxis. Clin Colon Rectal Surg, 2013, 26(3):153-159.
7. 袁训芝, 吴新民, 袁家颖, 等.压力梯度长袜和间歇充气装置预防恶性肿瘤患者术后下肢深静脉血栓形成的效果.中华麻醉学杂志, 2006, 26(2):103-106.
8. Vaitkus PT, Leizorovicz A, Cohen AT, et al. Mortality rates andrisk factors for asymptomatic deep vein thrombosis in medical patients. Thromb Haemost, 2005, 93(1):76-79.
9. Saxena A, Mittal A, Arya SK, et al. Safety and efficacy of low-molecular-weight heparins in prophylaxis of deep vein thrombosis in postoperative/ICU patients:A comparative study. J Nat Sci Biol Med, 2013, 4(1):197-200.
10. Mismetti P, Laporte S, Darmon JY, et al. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolismin general surgery. Br J Surg, 2001, 88 (7):913-930.
11. 陶国全, 葛恒发, 姜宝飞, 等.腹腔镜结直肠术后并发症的处理.中华消化外科杂志, 2011, 10(1):47-47.
12. 叶华, 陈平, 郑祺, 等.胃癌术后早期应用低分子肝素对静脉血栓形成的影响.中华普通外科杂志, 2014, 29(011):875-876.
13. 纪烈辰, 俞林.直肠癌术后应用低分子肝素预防静脉血栓性疾病的价值.中华消化外科杂志, 2013, 12(6):428-430.
14. Fanikos J, Piazza G, Zayaruzny M, et al. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost, 2009, 102(4):688-693.
15. Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med, 2006, 355 (17):1780-1789.
16. 邵新宏, 包文.下肢深静脉血栓手术与溶栓治疗效果的比较.中国普外基础与临杂志, 2011, 18(12):1309-1313.
17. 马志强, 魏松洋, 杨瑞丽, 等.下肢深静脉血栓形成的治疗经验.中国普外基础与临床杂志, 2011, 18(2):202-203.

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术后早期应用低分子肝素对胃肠道恶性肿瘤术后深静脉血栓形成的影响

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