肝硬化脾功能亢进部分脾动脉栓塞术后严重并发症相关因素分析

Therelated factors of severe complications occurring after partial splenic artery embolization for hypersplenism due to cirrhosis:a clinical analysis

目的探讨肝硬化脾功能亢进(脾亢)患者经部分脾动脉栓塞术(PSE)后发生严重并发症的相关因素。方法收集2010年6月至2015年6月昆明医科大学第一附属医院采用PSE术治疗的242例肝硬化脾亢患者完整临床资料。采用Logistic回归模型、受试者工作特征曲线(ROC),分析PSE术后严重并发症发生相关因素。结果 PSE术后242例肝硬化脾亢患者中19例(7.9%)出现严重并发症。单因素分析显示,术前血小板水平(P=0.025)、腹水(P=0.044)、Child-Pugh评分(P=0.008)、术前脾体积(P=0.013)、栓塞体积(P=0.006)、脾栓塞率(P=0.025)与PSE术后是否发生严重并发症相关;多因素分析显示,栓塞体积(P=0.012)和Child-Pugh评分(P=0.016)是PSE术后发生严重并发症的独立危险因素。ROC曲线分析显示,这两个因素的截断值为551.4 cm3和10.5分。结论脾栓塞体积过大和术前高Child-Pugh评分可能引起肝硬化脾亢患者PSE术后严重并发症。

Objective To investigate the related factors of the severe complications occurring after partial splenic artery embolization （PSE） for hypersplenism due to cirrhosis. Methods The complete clinical data of 242 patients with hypersplenism due to cirrhosis, who were treated with PSE at the First Affiliated Hospital of Kunming Medical University during the period from June 2010 to June 2015, were collected. Using logistic regression model and receiver operating characteristic curve （ ROC ） the related factors of the severe complication occurring after PSE were analyzed. Results Of the 242 patients with hypersplenism and cirrhosis, 19 patients（7.9% ） developed severe complications after PSE. Univariate analysis showed that the related factors of serious complications included preoperative platelet level （P= 0.025）, ascites （P= 0.044）, Child-Pugh score （P=0.008）, preoperative splenic volume （P = 0.013）, infarcted splenic volume （P = 0.006）, and splenic infarction ratio （P = 0. 025 ）. Multivariate analysis indicated that the independent risk factors related to the occurrence of serious complications were infarcted splenic volume （ P = 0.016） and Child-Pugh score （ P = 0.012）. ROC analysis revealed that the cut-off values for infarcted splenic volume and for Child-Pugh score were 551.4cm^3 and 10.5 points respectively. Conclusion The larger infarcted splenic volume and the higher preoperative Child- Pugh score may cause severe complications after PSE.