腹腔镜脾切除联合贲门周围血管离断术后发生门静脉血栓的影响因素分析

Influencing factors for portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection

目的探讨腹腔镜脾切除联合贲门周围血管离断术后发生门静脉血栓的影响因素。方法采用回顾性病例对照研究方法。收集扬州大学临床医学院2014年9月至2017年1月收治的106例门静脉高压症乙型病毒性肝炎肝硬化患者的临床病理资料;男83例,女23例;年龄为(51±11)岁。患者均施行腹腔镜脾切除联合贲门周围血管离断术。观察指标:(1)患者术后血栓发生及治疗情况。(2)腹腔镜脾切除联合贲门周围血管离断术后发生门静脉血栓的影响因素。正态分布的计量资料以x±s表示,组间比较采用t检验;计数资料以绝对数表示,组间比较采用χ^(2)检验。单因素分析采用对应的统计学检验方法。多因素分析采用Logistic回归模型前进法。结果(1)患者术后血栓发生及治疗情况。106例患者均获得术后1个月随访,随访期间35例发生门静脉主干或肝内分支血栓,其中血栓位于门静脉主干23例、门静脉肝内右支1例、门静脉主干及右支5例、门静脉主干及左支5例、门静脉肝内左支1例。35例发生门静脉系统血栓患者中,17例行华法林治疗,18例行阿司匹林治疗。(2)腹腔镜脾切除联合贲门周围血管离断术后发生门静脉系统血栓的影响因素。多因素分析结果显示:术前门静脉直径是术后门静脉系统发生血栓的独立影响因素(优势比=1.559,95%可信区间为1.200~2.027,P<0.05)。结论术前门静脉直径是腹腔镜脾切除联合贲门周围血管离断术患者术后发生门静脉系统血栓的独立影响因素。

Objective To investigate the influencing factors for portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection(LSD).Methods The retrospective case-control study was conducted.The clinicopathological data of 106 patients with portal hyperten‑sion,type B viral hepatitis and cirrhosis who were admitted to Clinical Medical College of Yangzhou University from September 2014 to January 2017 were collected.There were 83 males and 23 females,aged(51±11)years.All patients underwent LSD.Observation indicators:(1)incidence of postoperative thrombosis and treatment;(2)influencing factors for portal vein thrombosis after LSD.Measure‑ment data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi‑square test.Univariate analysis was conducted by corresponding statistic methods.Multivariate analysis was conducted by Logistic stepwise regression model with forward method.Results(1)Incidence of postoperative thrombosis and treatment.All 106 patients were followed up in the postoperative 1 month.During the follow‑up period,35 patients had thrombosis occurred in main and intrahepatic branches of portal vein,including 23 cases with thrombosis occurred in main portal vein,1 case with thrombosis occurred in intrahepatic right branches of portal vein,5 cases with thrombosis occurred in main and intrahepatic right branches of portal vein,5 cases with thrombosis occurred in main and intrahepatic left branches of portal vein,1 case with thrombosis occurred in intrahepatic left branches of portal vein.Of the 35 patients with portal vein thrombosis,17 cases were treated with warfarin and 18 cases were treated with aspirin.(2)Influencing factors for portal vein thrombosis after LSD.Results of multivariate analysis showed that preoperative portal vein diameter was an independent factor influencing portal vein thrombosis after LSD(odds ratio=1.559,95%confidence interval as 1.200−2.027,P<0.05).Conclusion Preopera‑tive portal vein diameter is an independent factor influencing portal vein thrombosis after LSD.