腹腔镜脾脏切除术后门静脉系统血栓形成的危险因素及抗凝治疗:系统综述与Meta分析

Risk factors and anticoagulation therapy of portal vein thrombosis after laparoscopic splenectomy:a systematic review and Meta analysis

目的:对门静脉系统血栓形成(PSVT)的危险因素进行Meta分析,探讨腹腔镜脾切除术(LS)后预防PSVT的方法。方法:由两名研究人员独立检索自建库以来至2020年11月的PubMed、Web of Science、Medline、Scopus、中国期刊全文数据库,检索LS术后PSVT危险因素或药物预防的相关研究,采用Stata 12.0、Review Manager 5.3进行数据分析。结果:共纳入前瞻性研究3项,随机对照试验2项,回顾性队列研究13项,总体质量较高。门静脉直径[WMD=-1.86,95%CI(-2.26,-1.46),I2=13.0%,P<0.001]、脾脏重量[WMD=-409.78,95%CI(-517.96,-301.6),I2=32.9%,P<0.001]是PSVT的危险因素。在抗凝治疗预防PSVT时,新疗法组PSVT发生率低于常规治疗组,差异有统计学意义[RR=0.76,95%CI(0.61,0.94),I2=0,P=0.012]。结论:术前门静脉直径与脾脏重量是LS术后发生PSVT的良好预测指标。LS术后尽早应用抗凝药物对预防PSVT的发生是有效的。

Objective:To analyze the risk factors of portal or splenic vein thrombosis(PSVT)by Meta-analysis,and to find a better method to prevent PSVT after laparoscopic splenectomy(LS).Methods:Two researchers independently searched PubMed,Web of Science,Medline,Scopus and China journal full-text database from the date of establishment of the database to Nov.2020,in order to to screen the research on the risk factors or drug prophylaxis of PSVT after LS.All the analyses were conducted using Stata 12.0 and Review Manager 5.3.Results:This study included 3 prospective studies,2 randomized controlled trials and 13 retrospective cohort studies,the general quality of the papers were of high standard.The diameter of portal vein[WMD=-1.86,95%CI(-2.26,-1.46),I2=13.0%,P<0.001]and spleen weight[WMD=-409.78,95%CI(-517.96,-301.6),I2=32.9%,P<0.001]were risk factors for PSVT.For anticoagulant therapy to prevent the occurrence of PSVT,the incidence of PSVT in the new treatment group was significantly lower than that in the routine treatment group,and the difference was statistically significant[RR=0.76,95%CI(0.61,0.94),I2=0,P=0.012].Conclusions:Preoperative portal vein diameter and spleen weight are good predictors of PSVT after LS.In addition,the use of anticoagulants as early as possible after LS is effective in preventing the occurrence of PSVT.