摘要
目的探讨肝硬化脾功能亢进症(脾亢)脾切除术后门静脉血栓形成(PVT)的危险因素。方法回顾性分析2016年7月至2019年4月于中山大学附属第三医院行脾切除术的136例肝硬化脾亢患者临床资料。其中男101例,女35例;平均年龄为(48±11)岁。病毒性肝炎113例,肝豆状核变性8例。患者均签署知情同意书,符合医学伦理学规定。根据术后有无发生PVT,将患者分为PVT组(77例)和非PVT组(59例)。收集患者围手术期临床相关指标,采用单因素和Logistic多因素回归分析PVT形成的危险因素,ROC曲线分析危险因素诊断最佳界值。结果肝硬化脾亢脾切除术后PVT发生率57%(77/136),75%(58/136)的PVT发生在术后10 d内。单因素分析显示,内镜治疗史、术前凝血酶时间(TT)、脾脏长径、脾肋间厚径、门静脉内径、术前脾静脉内径和术后门静脉内径、手术当天及术后5~6 d RBC、手术当天Plt、术后2~4 d TT与术后PVT发生有关(P<0.05)。Logistic多因素分析显示,内镜治疗史、手术当天Plt、术后门静脉内径是术后PVT发生的独立影响因素(OR=3.556,1.020,1.449;P<0.05)。ROC曲线分析显示,手术当天Plt>62×10^(9)/L诊断术后PVT的敏感度0.597,特异度0.593;术后门静脉内径>13.5 mm诊断术后PVT的敏感度0.390,特异度0.864。结论肝硬化脾亢脾切除术后PVT发生率较高,术后门静脉内径>13.5 mm、术后当天Plt>62×10^(9)/L及内镜治疗史是肝硬化脾亢脾切除术后发生PVT的独立危险因素。
Objective To investigate the risk factors of portal vein thrombosis(PVT)after splenectomy in patients with cirrhotic hyperplenism.Methods Clinical data of 136 cirrhosis patients complicated with hypersplenism who underwent splenectomy in the Third Affiliated Hospital of Sun Yat-senUniversity from July 2016 to April 2019 were retrospectively analyzed.Among them,101 patients were male and 35 female,aged(48±11)years on average.113 cases were diagnosed with viral hepatitis and 8 cases of hepatolenticular degeneration.The informed consents of all patients were obtained and the local ethical committee approval was received.According to postoperative incidence of PVT,all patients were divided into the PVT(n=77)and non-PVT groups(n=59).Clinical indexes were collected during perioperative period.The risk factors of PVT were analyzed by univariate and multivariate Logistic regression analyses,and the optimal diagnostic threshold values of risk factors were analyzed by the ROC curve.Results The incidence of PVT was 57%(77/136)after splenectomy in patients with cirrhotic hyperplenism,and 75%(58/136)occurred within 10 d after splenectomy.Univariate analysis showed that endoscopic treatment history,preoperative thrombin time(TT),splenic maximum diameter,splenic intercostal thickness,portal vein diameter,preoperative splenic vein diameter and postoperative portal vein diameter,RBC on the day of surgery and 5-6 d after surgery,Plt on the day of surgery,and TT on 2-4 d after surgery were correlated with the incidence of postoperative PVT(P<0.05).Multivariate Logistic analysis showed that endoscopic treatment history,Plt on the day of surgery,and portal vein diameter were the independent factors influencing the incidence of postoperative PVT(OR=3.556,1.020,1.449;P<0.05).ROC curve revealed that the sensitivity and specificity of Plt>62×10^(9)/L on the day of surgery in the diagnosis of postoperative PVT were 0.597 and 0.593.The sensitivity and specificity of postoperative portal vein diameter>13.5 mm in the diagnosis of postoperative PVT were 0.390 and 0.864.Conclusions The incidence of PVT after splenectomy in patients with cirrhotic hyperplenism is relatively high.Postoperative portal vein diameter>13.5 mm,Plt>62×10^(9)/L on the day of surgery and endoscopic treatment history are the independent risk factors for PVT after splenectomy.
作者
苏日顺
卢逸
庄宝鼎
张译
李彦杰
徐见亮
Su Rishun;Lu Yi;Zhuang Baoding;Zhang Yi;Li Yanjie;Xu Jianliang(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Center for Digestive Disease,the Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518118,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2024年第1期39-44,共6页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
广东省中医药管理局项目(20211085)。
关键词
门静脉血栓
肝硬化
脾切除术
脾功能亢进
危险因素
门静脉内径
血小板
Portal vein thrombosis
Liver cirrhosis
Splenectomy
Hypersplenism
Risk factors
Diameter of portal vein
Platelet
