肝硬化脾切除术后门静脉血栓形成相关因素的Meta分析

Risk factors of portal vein thrombosis after splenectomy in cirrhotic patients： a Meta-analysis

目的 评价肝硬化脾切除术后门静脉血栓形成的相关因素,为脾切除术后血栓的预防提供参考.方法 计算机检索Web of Science、PubMed、EMBASE、Science Direct、CNKI、VIP、CSCD、万方等数据库,检索时间截止2014年4月.并辅以手工检索、文献追溯等方法.纳入有关肝硬化脾切除术后门静脉血栓形成相关因素的病例对照研究,并进行文献质量评价.由两位研究者独立提取数据并采用Stata 12软件进行Meta分析.结果 共纳入24项符合标准的病例对照研究,病例数为4 335例.其中脾切除术后发生血栓的患者1 028例,血栓发生率为25.0％.Meta分析结果显示,肝硬化脾切除术后门静脉血栓的形成与脾脏体积（WMD=13.75,95％ CI：6.47 ～ 21.00）、脾静脉直径（WMD=1.34,95％ CI：0.39～2.30）、手术前后门静脉直径（术前WMD＝ 1.54,95％ CI：0.56～2.52;术后WMD=2.09,95％CI：0.55 ～ 3.64）、手术前后门静脉血流速度（术前WMD=-5.78,95％ CI：-10.46～-1.10;术后WMD=-5.57,95％ CI：-5.92～-5.22）、手术前后门静脉压力差（WMD=1.90,95％CI：1.29～2.50）、腹水（OR=1.83,95％ CI：1.19～2.82）以及术后抗凝干预（OR=0.63,95％CI：0.50 ～0.79）等有关;而与患者的性别、年龄、肝功、血小板计数、术前总胆红素、手术前后门静脉压力、手术前后凝血酶原时间及D-二聚体、手术时间以及糖尿病无关.结论 肝硬化脾切除术后门静脉血栓形成的主要危险因素为脾脏体积、脾静脉直径、门静脉直径、门静脉血流速度、腹水等,与患者基本情况、凝血相关指标、手术时间等无直接相关性.

Objective To study the perioperative predictors of portal vein thrombosis （PVT） after splenectomy in cirrhotic patients.Methods We searched the Web of Science,PubMed,EMBASE,Science Direct,CNKI,VIP,CSCD,and Wan Fang Databases up to April 2014.Only case-controlled studies which evaluated predictive factors of portal vein thrombosis （PVT） after splenectomy in cirrhotic patients were included.The Stata 12 software was used to perform the meta-analysis.Results Twenty-four casecontrolled studies were included.The sample size was 4 335,and the incidence rate of PVT was 25.0％.The risk factors of PVT included splenic volume （WMD =13.75,95％ CI：6.47 ～21.00）,splenic vein diameter （WMD =1.34,95％ CI：0.39 ～ 2.30）,portal vein diameter （WMD =1.54,95 ％ CI：0.56 ～ 2.52 ;WMD=2.09,95％CI：0.55 ～3.64）,portal venous flow （WMD =-5.78,95％ CI：-10.46 ～-1.10;WMD =-5.57,95 ％ CI：-5.92 ～-5.22）,difference in portal venous pressure （WMD =1.90,95 ％ CI：1.29～2.50） and ascites （OR =1.83,95％ CI：1.19,2.82）.There were no significant differences between patients with and without PVT in terms of sex,age,Child-Pugh classification,prothrombin time,PLT,D-dimer,operating time.Conclusion The risk factors of portal vein thrombosis after splenectomy in cirrhotic patients were splenic volume,splenic vein diameter,portal vein diameter,portal venous flow,difference in portal venous pressure and ascites.