晚期肝硬化门静脉高压症脾切除术后发生门静脉血栓的相关因素分析

Risk factor analysis of portal vein thrombosis after splenectomy for portal hypertension due to cirrhosis

目的探究晚期肝硬化门静脉高压症患者接受脾切除术后发生门静脉血栓的相关因素,为临床提供应对措施和预防提供依据。方法选取2008年1月到2013年12月接受脾切除治疗的晚期肝硬化门静脉高压症患者100例,对患者术前一般情况(年龄、性别、出血史、出血量、门静脉内径等)、手术方式、手术后相关临床指标等临床资料进行统计,采用Pearson单因素分析及Logistic多因素回归分析探讨晚期肝硬化门静脉高压症脾切除术后发生门静脉血栓的相关因素。结果本组患者中有血栓者45例,无血栓者55例。Pearson单因素分析显示,患者出现血栓与性别、年龄、手术方式、上消化道出血史及手术时间无显著相关性(P>0.05),然而有血栓组术中出血量≥350 m L、门静脉直径≥1.2 cm、术后血流速度<15 cm/s、术后血小板计数≥700×109/L及术后门静脉压力≥35 cm H2O的比例明显高于对照组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,术中失血量、术后血小板计数、术后血流速度、门静脉直径大小及术后门静脉压力是晚期肝硬化门静脉高压症脾切除术后发生门静脉血栓的相关因素。结论术中减少患者失血量,术后积极监测患者血常规以及凝血功能,并给予积极治疗可以有效降低晚期肝硬化门静脉高压症脾切除术后发生门静脉血栓的风险。

Objective To investigate the risk factors of portal vein thrombosis in cirrhotic patients who underwent splenectomy due to portal hypertension in order to provide the basis for clinical management and preventive measures.Methods Totally,100 patients with portal hypertension due to cirrhosis,who were treated in our hospital from Jan 2008 to Dec 2013,were selected.They were divided into experimental group（with portal vein thrombosis after splenectomy）and control group（without portal vein thrombosis after splenectomy）.Clinical data of the patients were retrospectively analyzed.Results There were 45 patients in experimental group and 55 in control group.There were no significant differences in sex ratio,age,operation mode,history of upper gastrointestinal bleeding and operation time between the two groups（P 〉0.05）.The proportions of patients with blood loss over 350 m L,diameter of portal vein over 1.2 cm,velocity of blood flow below 15 cm/s,platelet count over 700 × 10^9/L and portal vein pressure over 35 cm H2 O in experimental group were higher than those in control group（P〈0.05）.By logistic multiple regression analysis,blood loss,diameter of portal vein,velocity of blood flow,platelet count and portal vein pressure were risk factors of portal vein thrombosis after splenectomy for portal hypertension due to cirrhosis.Conclusion Strict regulation of the operation withdecreased blood loss and postoperative monitoring of blood routine test and coagulation function with active treatment can effectively reduce the incidence of postoperative portal vein thrombosis.