肝硬化脾切除术后门静脉系统血栓形成的危险因素分析

Risk factors of portal vein thrombosis after splenectomy in patients with liver cirrhosis and portal hypertension

目的分析影响肝硬化患者脾切除术后门静脉系统血栓形成(PVT)的危险因素。方法2015年1月~2018年6月我院收治的肝硬化患者94例,接受脾切除联合食管下段周围曲张血管离断术,使用彩色多普勒超声检查门静脉系统。采用多因素Logistic回归分析影响术后PVT形成的危险因素。结果术后1个月随访,经彩色多普勒超声检查,发现PVT形成30例,未发生PVT患者64例;PVT组有腹水者为56.7%,显著高于无PVT组的32.8%(P<0.05),脾脏厚度为(75.8±9.4)mm,显著大于无PVT组【(69.1±8.8)mm,P<0.05】,脾脏体积为(141.7±18.1)mm2,显著大于无PVT组【(126.8±17.2)mm2,P<0.05】,门静脉内径为(16.2±2.1)mm,显著大于无PVT组【(14.1±1.9)mm,P<0.05】,门静脉血流流速为(12.2±1.5)cm/s,显著慢于无PVT组【(14.6±1.6)cm/s,P<0.05】;应用低分子右旋糖苷或低分子肝素抗凝干预患者所占比例显著低于无PVT组(P<0.05);Logistic回归分析显示,未应用抗凝治疗(OR=0.503,P=0.023)、门静脉流速减慢(OR=0.491,P=0.014)、脾脏体积增加(OR=1.872,P=0.044)和门静脉内径增宽(OR=1.982,P=0.021)是肝硬化脾切除术患者术后PVT形成的独立危险因素。结论肝硬化脾切除术患者术后可能存在PVT形成,了解一些危险因素并给予积极的干预可能减少PVT形成的发生,使患者获益。

Objective To analyze the risk factors of portal vein thrombosis(PVT)after splenectomy in patients with liver cirrhosis and portal hypertension.Methods 94 patients with liver cirrhosis and portal hypertension were admitted to our hospital between January 2015 to June 2018,and all the patients received splenectomy and pericardial devascularization.Color Doppler ultrasonography was carried out for PVT.Multivariate Logistic regression analysis was applied to reveal the risk factors for postoperative PVT.Results 30 patients were found to have the PVT by ultrasonography one month after the operation,and the proportion of ascites in patients with PVT was significantly higher than that in non-PVT group[56.7%vs.32.8%,P<0.05],the spleen thickness was significantly greater than that in non-PVT group[(75.8±9.4)mm vs.(69.1±8.8)mm,P<0.05],the spleen volume was significantly larger than that in non-PVT group[(141.7±18.1)mm2 vs.(126.8±17.2)mm2,P<0.05],the portal vein diameter was significantly wider than that in non-PVT group[(16.2±2.1)mm vs.(14.1±1.9)mm,P<0.05],the portal vein velocity was significantly slower than that in non-PVT group[(12.2±1.5)cm/s vs.(14.6±1.6)cm/s,P<0.05],the proportion of patients had having low molecular weight dextran or low molecular weight heparin therapy was significantly lower than that in non-PVT group(P<0.05);the Logistic regression analysis showed that absence of anti-coagulative therapy(OR=0.503,P=0.023),slowed portal vein velocity(OR=0.491,P=0.014),increased spleen volume(OR=1.872,P=0.044)and increased portal vein diameter(OR=1.982,P=0.021)were the independent risk factors for postoperative PVT formation in patients with liver cirrhosis after splenectomy.Conclusions The clinicians must take the risk factors of PVT formation into consideration in dealing with portal hypertension by splenectomy and devascularization,and give the appropriate prophylactic management.