脾切断流术后门静脉血栓形成的危险因素及防治方法

Risk factors and prophylactic methods for portal venous thrombosis after splenectomy and devascularization

目的探讨脾切断流术后门静脉血栓形成（PVT）的危险因素及防治方法。方法回顾性分析2006年3月至2014年6月该院行脾切断流术的712例肝硬化门脉高压症患者的临床资料,分析术后发生PVT的危险因素和防治方法。结果 PVT发生率受年龄、肝功能等级、是否合并糖尿病和术后抗凝治疗,以及胃食管静脉曲张程度等5个因素影响。发生PVT的患者术前和术毕的门静脉压力及其差值均高于未发生PVT的患者（P〈0.05）。发生PVT的患者血小板计数及D-二聚体浓度均在术前到术后2周时增高,术后2周后开始降低,发生PVT的患者与未发生PVT的患者血小板计数差异无统计学意义（P〉0.05）,但在术后2-12周各时间点D-二聚体浓度差异均有统计学意义（P〈0.05）。结论肝功能低下、糖尿病、年龄、胃食管静脉曲张程度、术后抗凝治疗、D-二聚体浓度和门静脉压力是发生PVT的危险因素,术后积极改善危险因素对预防PVT形成有积极意义。

Objective To investigate the risk factors and prophylactic methods for portal venous thrombosis（PVT）after splenectomy and devascularization.Methods A retrospective analysis was performed on the clinical data in 712 cases of cirrhotic portal hypertension undergoing splenectomy and devascularization in our hospital from March2006 to June 2014.The risk factors of PVT occurrence after operation and prevention methods were analyzed.Results The occurrence rate of PVT was affected by the 5factors of age,liver function grade,whether complicating diabetes and postoperative anticoagulant therapy,and gastroesophageal varices,the differences were statistically significant（P〈0.05）.The portal venous pressure and its difference value before operation and at the end of operation in the patients with PVT occurrence were higher than those in the patients without PVT occurrence（P〈0.05）.The PLT count and D-dimer level in the patients with PVT occurrence were increased from before operation to postoperative 2weeks and started to decrease from postoperative 2weeks.The PLT count had no statistical difference between the patients with PVT occurrence and the patients without PVT occurrence（P〉0.05）,but the D-dimer levels had statistical differences among various time points during postoperative 2-12weeks（P〉0.05）.Conclusion Liver dysfunction,diabetes,age,gastroesophageal varices degree and postoperative anticoagulant therapy,D-dimer level and portal venous pressure are the risk factors of PVT occurrence after splenectomy and devascularization,actively improving the risk factors after operation has an active significance for the prevention of PVT.