腹腔镜选择性贲门周围血管离断联合脾切除术后再出血的危险因素分析

Multivariate regression analysis of rebleeding related factors after laparoscopic selective pericardial devascularization combined with splenectomy

目的分析腹腔镜选择性贲门周围血管离断联合脾切除术(以下简称“腹腔镜选择性断流术”)后再出血的危险因素。方法回顾性分析2014年2月至2018年9月期间陕西中医药大学附属医院收治的147例行腹腔镜选择性断流术治疗门静脉高压症病例的临床资料,对影响其再出血的因素进行logistic回归分析。结果本组147例行腹腔镜选择性断流术患者中有20例(13.6%)发生了再出血。腹腔镜选择性断流术后发生了再出血和未再出血患者的血小板计数、凝血酶原时间、血清白蛋白、门静脉主干直径、肝功能分级、腹水、肝性脑病及门静脉高压性胃病方面比较差异均有统计学意义(P<0.050)。采用logistic回归方法进行分析发现肝功能分级[OR=3.444,95%CI(1.211,9.793),P=0.020]、腹水[OR=2.859,95%CI(1.069,7.645),P=0.036]、肝性脑病[OR=4.265,95%CI(1.121,16.230),P=0.033]、门静脉高压性胃病]OR=6.744,95%CI(1.675,27.156),P=0.007]和血小板计数[OR=4.744,95%CI(1.073,20.969),P=0.040]是术后再出血的独立危险因素。结论对于行腹腔镜选择性断流术后存在再出血危险因素的患者术前应积极处理,术后应高度警惕预防再出血。

Objective To analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy. Methods The clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group(n=20) and the non-bleeding group(n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding. Results The rebleeding occurred in 20 of 147 patients(13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the nonbleeding group(P<0.050). The classification of liver function [OR=3.444, 95% CI(1.211. 9.793), P=0.020], ascites[OR=2.859, 95% CI(1.069, 7.645), P=0.036], hepatic encephalopathy [OR=4.265, 95% CI(1.121, 16.230), P=0.033], and portal hypertensive gastropathy [OR=6.744, 95% CI(1.675, 27.156), P=0.007], and platelet count [OR=4.744, 95% CI(1.073, 20.969), P=0.040] were the independent factors for the postoperative rebleeding by the logistic regression analysis.Conclusion For patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.