摘要
目的探讨肝硬化门静脉高压接受脾切除断流术后早期门静脉血栓形成的原因。方法对2012年1月-2013年12月首都医科大学附属北京佑安医院收治的83例脾切断流术后患者进行回顾性分析,随访时间3个月,根据是否发生门静脉血栓分为血栓组与对照组,计量资料组间比较采用t检验,计数资料比较采用χ2检验。采用Logistic回归模型进行多因素分析。结果 44例脾切断流术后患者发生门静脉血栓,发生率53.01%;血栓组与对照组间比较,术前门静脉直径、术后门静脉直径、脾脏容积、脾切除前后门静脉流速差差异均有统计学意义(P值分别为0.014、0.017、0.013、0.030),是术后早期门静脉血栓形成危险因素;Logistic回归分析显示手术前后门静脉流速差是术后门静脉血栓形成的独立危险因素(P=0.003);而手术前、后的门静脉血流流速,门静脉压力变化,手术时间,术中出血,血小板最高值与门静脉血栓形成均无关。结论血流动力学因素影响脾切断流术后门静脉血栓形成,抗凝治疗需个体化。
Objective To identify the causative factors for early portal vein thrombosis（ EPVT） after esophagogastric devascularization and splenectomy（ EGDS） in cirrhotic patients with portal hypertension. Methods A 3- month follow- up of a retrospective study was performed on 83 patients who received EGDS at our hospital from January 2012 to December 2013. The patients were assigned to thrombosis and control groups given the presence or absence of EPVT. Continuous and categorical data were compared between groups using t test and χ2test,respectively. Logistic regression models were adopted for multivariate analysis. Results EPVT occurred in 44 patients after EGDS,accounting for an incidence of 53. 01%. There were significant differences between the thrombosis and control groups in terms of preoperative portal vein diameter（ P = 0. 014）,postoperative portal vein diameter（ P = 0. 017）,spleen volume（ P = 0. 013）,and portal venous flow alteration（ P = 0. 030）; these four parameters were risk factors for EPVT after EGDS. Logistic regression analysis showed that portal venous flow alteration after surgery was an independent risk factor for EPVT（ P = 0. 003）; portal venous flow and pressure alterations after surgery,operation time,intraoperative bleeding,and maximum platelet count were unrelated to EPVT. Conclusion Hemodynamic factors impact EPVT after EGDS,for which individualized anticoagulant therapy is necessary.
出处
《临床肝胆病杂志》
CAS
2015年第3期400-403,共4页
Journal of Clinical Hepatology
关键词
肝硬化
高血压
门静脉
脾切除术
静脉血栓栓塞
危险因素
liver cirrhosis
hypertension,portal
splenectomy
venous thromboembolism
risk factors
