胃底静脉曲张组织黏合剂注射术后门静脉血栓形成的危险因素分析

Risk Factors of Portal Vein Thrombosis after Cyanoacrylate Injection for Gastric Varices

【目的】分析内镜下肝硬化并胃底静脉曲张组织黏合剂注射治疗（GVI）术后门静脉血栓发生率及与肝硬化疾病相关的影响门脉血栓形成的危险因素。【方法】回顾性分析我院2009年8月至2014年6月因肝硬化伴胃底重度静脉曲张住院并行首次胃底组织黏合剂治疗的患者157例。记录其临床资料,GVI术后1年内出现门脉血栓者为血栓组,未出现血栓者为非血栓组。应用Logistic回归模型,筛选肝硬化合并胃底静脉曲张患者行GVI后发生门静脉血栓的危险因素。【结果】纳入本研究的157例患者中,首次GVI术后1年内出现门静脉血栓者39例,未出现门静脉血栓者118例,门静脉血栓发生率为24.84%。Logistic回归分析表明,术前脾长径、术中碘油注射量在血栓组及非血栓组中差异有统计学意义（P值分别为0.022、0.027;OR值分别为1.021、1.739,95%CI分别为1.003~1.040、1.066~2.837）。【结论】术前脾长径、术中碘油注射量可能是影响GVI术后门脉血栓形成的独立危险因素,肝硬化合并胃底静脉曲张患者行GVI术前需了解脾肿大情况,术中合理控制碘油注射量,以减少术后门静脉血栓发生的可能。

【Objective】 To identify the incidence and risk factors of portal vein thrombosis（PVT） after endoscopic cyanoacrylate injection for cirrhotic patients with gastric varices. 【Methods】 Retrospectively investigate the clinical, laboratory and imaging data of157 patients of cirrhosis admitted between August 2009 to June 2014 who underwent cyanoacrylate injection for severe gastric varices for the first time. The patients data were analyze according to presence or absence of PVT within one year postoperatively. Logistic regression was applied to investigate possible risk factors of PVT. 【Results】 Of the 157 cases, 39 patients presented PVT within one year aftercyanoacrylate injection, and the incidence rate of PVT was 24.8%. There were significant differences between the two groups for the length of spleen preoperatively（OR： 1.021, 95%CI： 1.003~1.040, P = 0.022） and the volume of iodinated oil used in the operation（OR：1.739,95% CI： 1.066 ~ 2.837,P = 0.027）. 【Conclusion】 The length of spleen preoperatively and the volume of iodinated oil used in the operation were considered to be independent risk factors for PVT. We should pay more attention to the splenomegaly before treating patients of gastric varices with cyanoacrylate injection, and proper volume of iodinated oil used during the procedure is also of importance to decrease PVT occurrence.