肝炎肝硬化脾切除术后门静脉系统血栓形成的相关因素分析和预防

Relevant factors and prevention of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis

目的分析肝炎肝硬化门静脉高压症脾切除术后门静脉系统形成血栓的相关因素,寻找预防门静脉高压症脾切除术后门静脉系统形成血栓的方法。方法回顾性分析我院1999年3月至2005年6月收治的肝炎肝硬化门静脉高压症行单纯脾切除、脾切除加EVL或脾切除加贲门周围血管断流术的病人132人,用Logistic回归分析分析术前肝功能Child-Pugh分级、门静脉和脾静脉直径、脾脏的大小以及术后血小板的数量与门静脉系统血栓形成的关系;将其中符合要求的112人分为三组,A组56人:术后未用抗凝、祛凝药;B组33人:术后在血小板＞300×109／L时用抗凝、祛凝药; C组23人:术后早期应用抗凝、祛凝药。比较三组门静脉系统血栓的发生率。结果Logistic单因素分析提示门静脉系统的血栓形成与门静脉直径、脾脏的大小、脾脏的厚度、血清总胆红素以及术后血小板的数量有关;多因素回归分析发现门静脉系统的血栓形成与门静脉和脾静脉直径、脾脏的大小和是否行抗凝祛凝治疗有关;A组、B组和C组门静脉系统发生血栓的人数分别为19人、9人和1人,发生率分别为33．9％、27．3％和4．3％,门静脉血栓发生率的比较A组和B组的差异无显著性(x2= 0.427,P=0.514),A组和C组的差异有显著性(x2=7.545.082,P=0.006),B组和C组的差异有显著性(x2=4．856,P=0.028)。结论肝炎肝硬化门静脉高压症脾切除术后门静脉系统血栓的形成与门静脉和脾静脉直径、脾脏的大小和是否行抗凝祛凝治疗有关;早期、全身应用抗凝、祛凝药能有效的预防肝炎肝硬化门静脉高压症脾切除术后门静脉系统血栓的形成。

Objective To analyze the relevant factors and explore methods for prevention of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis. Methods The clinical data of 132 patients with portal hypertension due to cirrhosis resulting from hepatitis receiving simple splenectomy, splenectomy and EVL or splenectomy and portaazygous devascularization in our hospital from March 1999 to June 2005 were retrospectively analyzed. The relation of portal vein thrombosis to average diameter of main portal vein, average diameter of splenic vein, splenomegaly and number of thrombocytes after operation was studied by logistic regression analysis. Of the 112 that had the conditions being conformed to relevant standards, 56 did not undergo anticoagulation therapy after operation （group A）, 33 received anticoagulation therapy after operation when platelet count was over 300× 10^9/L （group B）, 23 underwent anticoagulation therapy in the early stage after operation （group C）. The incidence of the portal system thrombosis was compared among the 3 groups. Results Regression univariate analysis showed that the portal vein thrombosis was related to the average diameter of main portal vein, splenomegaly, thickness of spleen, serum level of total bilirubin, number of thrombocytes after operation. However, multivariate analysis revealed that the portal vein thrombosis was related to the average diameter of main portal vein, diameter of spleen vein, splenomegaly and anticoagulation therapy. All the 112 patients received color Doppler ultrasonography 3 weeks after the operation. The portal system thrombosis occurred in 19 patients （33. 9%） in group A, 9 （27.3%） in group B and 1 （4.3%） in group C. The incidence of portal system thrombosis was not significantly different between group A and B （P= 0. 514） but markedly different between group A and C （P=0. 006） and between group B and C （P=0. 028）. Conclusions The portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis is related to the average diameter of main portal vein, diameter of spleen vein, splenomegaly and anticoagulation therapy. Anticoagulation therapy given in the early stage can prevent the occurrence of the portal system thrombosis.