[1]王鹏利,周小燕,王少辉,等.通腹逐瘀颗粒预防肝硬化脾切除术后门静脉血栓形成临床研究[J].陕西中医,2025,46(2):206-210.[doi:DOI:10.3969/j.issn.1000-7369.2025.02.012]
　WANG Pengli,ZHOU Xiaoyan,WANG Shaohui,et al.Prevention of Tongfu Zhuyu granules on portal vein thrombosis after splenectomy in liver cirrhosis[J].,2025,46(2):206-210.[doi:DOI:10.3969/j.issn.1000-7369.2025.02.012]
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通腹逐瘀颗粒预防肝硬化脾切除术后门静脉血栓形成临床研究
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
46
期数:
2025年2期
页码:
206-210
栏目:
临床研究
出版日期:
2025-02-05

文章信息/Info

Title:
Prevention of Tongfu Zhuyu granules on portal vein thrombosis after splenectomy in liver cirrhosis
作者:
王鹏利; 周小燕; 王少辉; 罗 璐; 白 垚; 白子墨
(陕西中医药大学附属医院,陕西 咸阳 712000)
Author(s):
WANG Pengli; ZHOU Xiaoyan; WANG Shaohui; LUO Lu; BAI Yao; BAI Zimo
(Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)
关键词:
肝硬化;  通腹逐瘀颗粒;  脾切除术;  门静脉血栓;  纤维蛋白原;  D-二聚体
Keywords:
Liver cirrhosis;  Tongfu Zhuyu granules;  Splenectomy;  Portal vein thrombosis;  Fibrinogen;  D-dimer
分类号:
R 575.2
DOI:
DOI:10.3969/j.issn.1000-7369.2025.02.012
文献标志码:
A
摘要:
目的:探究通腹逐瘀颗粒对肝硬化患者经脾切除术后发生门静脉血栓的预防效果。方法:选取肝硬化失代偿期后出现门静脉高压症伴脾大、脾功能亢进的患者,给予脾切除术联合贲门胃底周围血管离断术,收集其中150例患者随机分为试验组、对照组、空白组各50例,其中试验组运用通腹逐瘀颗粒治疗,对照组术后3 d开始常规使用低分子肝素钠针剂皮下注射,空白组仅给予常规综合治疗,不做干预。于术后7 d、15 d检测患者的纤维蛋白原(FIB)、D-二聚体、丙氨酸氨基转移酶(ALT)、D-乳酸水平,门静脉平均血流速度及门静脉直径,记录并比较三组患者的术后首次排气、排便时间及术后住院时间,并且在术后7 d、15 d、3个月及6个月时,采用彩色多普勒超声检查监测门静脉血栓的发生情况,以此评估预防措施的有效性。结果:对三组患者检测指标进行分析,除术后7 d门静脉直径外,其他所有指标差异均有统计学意义(P<0.05)。在术后的7 d、15 d,试验组在FIB、D-二聚体、ALT、D-乳酸以及门静脉平均血流速度方面,与空白组比较差异具有统计学意义(P<0.05),其中试验组术后7 d、15 d的ALT、D-乳酸水平低于对照组(P<0.05),试验组术后15 d的FIB、D-二聚体、门静脉平均血流速度与对照组比较差异具有统计学意义(P<0.05)。术后15 d,试验组与对照组的门静脉直径大于空白组,试验组大于对照组(P<0.05)。术后恢复上,试验组与对照组的首次排气、排便、总住院时间较空白组明显缩短,试验组较对照组也显著缩减(P<0.05)。术后B超随访,试验组术后6个月内门静脉血栓总发生率低于空白组(P<0.05)。结论:运用通腹逐瘀颗粒能对肝硬化脾切除患者术后预后起到较为良好的效果,可预防门静脉血栓的形成。
Abstract:
Objective:To explore the preventive effect of Tongfu Zhuyu granules on portal vein thrombosis after splenectomy in patients with liver cirrhosis.Methods:Patients with portal hypertension,splenomegaly and hypersplenism after decompensated cirrhosis were selected and treated with splenectomy combined with pericardial and fundocial devascularization.The clinical data of 150 patients were collected and randomly divided into three groups:the experimental group(n=50),the control group(n=50)and the blank group(n=50).The treatment group was treated with Tongfu Zhuyu granule,the control group was treated with low-molecular-weight heparin sodium injection from the third day after operation,and the blank group was only treated with conventional comprehensive treatment without intervention.The levels of fibrinogen(FIB),D-dimer,alanine aminotransferase(ALT),D-lactic acid,mean portal vein blood flow velocity and portal vein diameter were measured on the 7th and 15th day after operation.The first postoperative exhaust time,defecation time and postoperative hospital stay were recorded and compared among the three groups.At the same time,color Doppler ultrasound was performed on the 7th day,15th day,3 months and 6 months after operation to detect the occurrence of portal vein thrombosis and evaluate the prevention effect.Results:Except for portal vein diameter on the 7th day after operation,the other indicators of the three groups were statistically significant(P<0.05).The levels of FIB,D-dimer,ALT,D-lactic acid and mean portal blood flow velocity in the experimental group were significantly different from those in the blank group at 7 and 15 days after operation(P<0.05).The levels of ALT and D-lactic acid in the experimental group were lower than those in the control group at 7 and 15 days after operation(P<0.05).FIB,D-dimer and portal vein blood flow velocity in the experimental group were significantly different from those in the control group 15 days after operation(P<0.05).At 15 days after operation,the diameter of portal vein in the experimental group and the control group was larger than that in the blank group,and that in the experimental group was larger than that in the control group(P<0.05).In terms of postoperative recovery,the first exhaust time,defecation time,and total hospital stay in the experimental group and the control group were significantly shorter than those in the blank group,and the experimental group was also significantly shorter than the control group(P<0.05).The total incidence of portal vein thrombosis within 6 months after operation was lower than that of the blank group(P<0.05).Conclusion:The use of Tongfu Zhuyu granules can have a good effect on the prognosis of patients with cirrhosis after splenectomy,prevent the formation of portal vein thrombosis.

参考文献/References:

[1] 祁小龙.肝硬化门静脉高压症前期:一个肝硬化病程进展的特定阶段[J].中华医学杂志,2022,102(8):535-537.
[2] FEROZ M B,ANIRUDH M,WOLFGANG E L,et al.Portal hypertension:Imaging of portosystemic collateral pathways and associated image-guided therapy[J].World Journal of Gastroenterology,2017,23(10):1735-1746.
[3] 孙文兵,张珂,张效东,等.原位脾脏切除术256例体会[J].中华肝胆外科杂志,2003,9(10):602-604.
[4] 徐伟,程瑶,涂兵.乙型肝炎肝硬化患者行脾切除术后门静脉血栓形成的列线图预测模型的建立与验证[J].南方医科大学学报,2020,40(9):1265-1272.
[5] 王建雄,魏丰贤,谢文强,等.脾切除对肝硬化门静脉高压脾功能亢进患者影响的研究进展[J].中国普通外科杂志,2022,31(1):123-131.
[6] 中华医学会消化病学分会肝胆疾病学组.肝硬化门静脉血栓管理专家共识(2020年,上海)[J].中华肝脏病杂志,2020,28(12):9.
[7] 宋子敏,戴朝六.肝硬化门脉高压症脾切除术后门静脉系统血栓形成的诊治进展[J].中国现代普通外科进展,2019,22(12):5.
[8] 徐小元,丁惠国,李文刚,等.肝硬化诊治指南[J].临床肝胆病杂志,2019,35(11):2408-2425.
[9] 中华医学会外科学分会脾及门静脉高压外科学组.肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J].中华消化外科杂志,2019,18(12):1087-1093.
[10] INTAGLIATA M N,CALDWELL H S,TRIPODI A.Diagnosis,development,and treatment of portal vein thrombosis in patients with and without cirrhosis[J].Gastroenterology,2019,156(6):1582-1599.
[11] AINA A,GENiS C,VALERIA P,et al.The pathophysiology of portal vein thrombosis in cirrhosis:Getting deeper into virchow's triad[J].Journal of Clinical Medicine,2022,11(3):800.
[12] ZHAO C Q,LYU J,XU L M Research progress of cirrhosis with portal vein thrombosis[J].Zhonghua Gan Zang Bing Za Zhi,2019,27(12):933-937.
[13] CHU H K,CHEN L Y,YANG L.Complexities and challenges in the management of portal vein thrombosis in cirrhosis[J].Zhonghua Gan Zang Bing Za Zhi,2021,29(3):196-198.
[14] 王鹏利,周晓燕,王建华,等.通腑逐瘀汤治疗脾切除术后胃肠功能障碍的临床研究[J].现代中医药,2016,36(6):37-39.
[15] 中华中医药学会肝胆病专业委员会,中国民族医药学会肝病专业委员会.慢性乙型肝炎中医诊疗指南(2018年版)[J].中西医结合肝病杂志,2019,29(1):97-102.
[16] 赖春林.四君子汤对重症胃肠功能障碍患者营养状况的影响[J].光明中医,2020,35(5):634-636.
[17] 李晓东,郑本波,刘山.脾切除联合贲门周围血管离断术治疗肝硬化并发门静脉高压症患者血细胞和肝功能的变化[J].实用肝脏病杂志,2018,21(2):289-290.
[18] 韩东,彭经纬,谢辉晋.脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症患者预防门静脉血栓形成研究[J].实用肝脏病杂志,2020,23(3):409-412.
[19] LIU C,HAN Z,ZHANG N,et al.Laparoscopic sleeve gastrectomy affects coagulation system of obese patients[J].Obesity Surgery,2020,30(10):3989-3996.
[20] REN C,LU H,XIA H,et al.Alterations of coagulation and fibrinolysis in patients with blunt splenic injury after splenic artery embolization[J].J Clin Lab Anal,2021,35(6):23801.
[21] JIANG M,MI L,NA L,et al.Pyrrolizidine alkaloid-induced hepatotoxicity associated with the formation of reactive metabolite-derived pyrrole-protein adducts[J].Toxins,2021,13(10):723-723.
[22] POHANKA M.D-lactic acid as a metabolite:Toxicology diagnosis and detection[J].Bio Med Research International,2020,2020(2):1-9.
[23] 辜嘉宇,唐勇,孙释然,等.脾切断流术后门静脉血栓形成防治的研究进展[J].中华肝胆外科杂志,2021,27(10):4.
[24] 卢伟,潘梦,方亦可,等.中药治疗急性肝损伤作用机制研究进展[J].中南药学,2019,17(9):1504-1507.
[25] 何海燕,黄书桐,赵唐莲,等.基于SIRT6/NF-κB信号通路研究复方桃仁丹参汤对急性肝损伤大鼠的保护作用[J].中药药理与临床,2021,37(1):148-152.

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备注/Memo

备注/Memo:
[基金项目]陕西省中医药管理局中医药科研课题(LCWS046)
更新日期/Last Update: 2025-02-08