脾切除术后并发症发生相关危险因素分析  

ANALYSIS OF MULTIPLE RISK FACTORS AFFECTING POSTOPERATIVE COMPLICATIONS IN SPLENECTOMY

作　　者：陈平[1] 王胜利[1] 

机构地区：[1]六安市中医院西外科,六安237006

出　　处：《肝胆外科杂志》2010年第6期456-458,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨脾切除术后并发症的影响因素。方法运用非条件Logistic回归分析方法对脾切除患者进行临床研究。结果脾切除术后并发症发生率36.20%（84/232）,感染15.09%（35/232）、出血10.34%（24/232）、脾热7.32%（17/232）、切口裂开4.74%（11/232）、肝衰3.88%（9/232）、胰腺损伤2.16%（5/232）、血栓栓塞0.86%（2/232）、胃肠穿孔0.43%（1/232）、死亡4.74%（11/232）。从全因素的Logistic回归模型的结果可见术前肝功能（X6）、乙肝后肝硬化脾大脾亢（X3）、急诊手术（X14）、脾破裂（X4）、主刀医师资格（X10）在a=0.05水平上显著,脾切除并发症的主要危险因素按其影响的大小顺次为：X6、X3、X14、X4,X10所对应的相对危险度在1.342~1.568之间,且X3、X14、X10为影响脾切除围手术期死亡的主要危险因素。逐步Logistic回归分析进一步肯定了上述结果,且乙肝后肝硬化脾大脾亢影响突出,P=0.0021,标准系数=0.213 202,相对危险度OR=2.347。而其他原因脾切除（X5）能减少脾切除并发症的发生。结论脾破裂、乙肝后肝硬化合并脾肿大脾亢zhud硬化合并脾肿大脾亢,tim e of occ lusion是脾切除术后并发症发生的重要危险因素,术前调整肝功能、合理选择手术时机、提高主刀医师手术操作水平是降低脾切除术后并发症发生和病死率的关键。Objective To study the influential factors of splenectomy complications in patients.Methods Logistic regressing analytic manner in normal conditions was used to retrospectively study the patients who had recieved splenectomy in our hospital.Results The incidence of splenectomy complications was 36.20%（84/232）,infection 15.09%（35/232）,including hemorrhage 10.34%（24/232）,Splenic fever 7.32%（17/232）,Wound dehiscence 4.74%（11/232）,liver failure 3.88%（9/32）、Pancreatic injury 2.16%（5/232）,and death 4.74%（11/232）.As shown in the results of regressing models including all the factors,preoperative liver function（X6）,liver cirrhosis（X3）,emergency surgery（X14） a,splenic rupture（X4） and surgeon＇squalification（X10） were obvious in the level of a=0.05.The ordinal major dangerous factors acting on the complications were X6、X3、X14、X4 and X10 with a coresponding relative risk of 1.342～1.568.During the period of perioperative time.the most dangerous factor related to the mortality was X3.Stepwise Logistic regressing analysis was used to testify the results,and showed that the factor of right hepatic lobectomy（X3）was significant with a P value of 0.0021（standard ratio=0.0.213 202,relative risk OR=2.347）.The incidence of splenectomy complications were decreased by splenectomy for other diseases（X5）.Conclusion Hepatitis B spongding liver cirrhosis and splenic rupture are important factors of the postoperative complications.Reasonable Timing of surgery,retaining more functional liver and improving the operational level of sergon is the key to reduce the splenectomy complications and mortality.

关 键 词：脾切除术 术后并发症 回归分析 

分 类 号：R659[医药卫生—外科学]