门静脉高压症脾切断流术后血栓形成的临床研究

Clinical Study on Portal Vein Thrombosis after Splenectomy and Devascularization

目的:探讨门静脉高压症脾切断流术后门静脉系统血栓形成的相关原因。方法:回顾性分析2010年4月-2011年12月我科450例因肝硬化门静脉高压症行脾切断流术患者的临床资料,应用超声多普勒检测手术前后门静脉血流速度、门静脉直径及脾静脉、肠系膜上静脉、门静脉血栓情况,用Logistic回归分析术前肝功能Child-Pugh分级、门静脉直径、门静脉血流速度、脾脏的质量及术后血小板数量与门静脉系统血栓形成的关系。结果:术前门静脉系统有血栓患者75例,占16.7%。术后门静脉血栓再形成率52.9%。Logistic单因素分析提示门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量、血清总胆红素、术后血小板数量有关。多因素分析发现门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量有关,而与血清总胆红素、术后血小板数量无关。结论:肝硬化门静脉高压症脾切除术后门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量有关。

Objective： To investigate the related factors of the portal venous system thrombosis after the splenectomy and devascularization. Methods： A retrospective analysis was conducted on the clinical data of 450 patients with liver cirrhosis and portal hypertension admitted in our department from April 2010 to December 2011 who were applied splenectomy and devascularization. Ultrasonic Doppler was used to detect the blood velocity of portal vein, the diameter of portal vein, splenic vein, superior mesenteric vein and portal vein thrombosis before and after the operation. Logistic regression was used to analyze the correlations between the preoperative Child-Pugh classification of liver function, portal vein diameter, blood velocity of portal vein, spleen weight, postoperative platelet count and portal venous system thrombosis. Results： 75 patients had preoperative portal vein system thrombosis which was accounted for 16.7%. The rate of postoperative portal vein thrombosis formation was 52.9%. Single factor analysis of Logistic showed that the formation of portal venous system thrombosis was associated with portal vein diameter, blood velocity of portal vein, spleen weight, serum total bilirubin and postoperative platelet count. Multiple analysis have shown that the portal vein thrombosis was related to portal vein diameter, blood velocity of portal vein, spleen weight and had no relation to the number of total serum bilirubin or postoperative platelet. Conclusions： Portal vein thrombosis after splenectomy and devascularization was related to portal vein diameter, blood velocity of portal vein, and spleen weight.