肝硬化门静脉高压症手术预后的危险因素  

Prognostic risk factors for surgery in patients with cirrhotic portal hypertension

作　　者：吕云福[1] 刘宁[1] 张世杰[2] 庞永斌[3] 岳劼[1] 

机构地区：[1]海南省人民医院普外科,海口570311 [2]广东省开平市中心医院外科 [3]陕西省延安大学附属医院

出　　处：《中华肝胆外科杂志》2012年第4期278-282,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝硬化门静脉高压症手术预后的危险因素。方法对本院近10年收治的161例肝硬化门静脉高压症手术患者资料，按预先设计的表格对24项临床及实验室指标进行收集、登记和统计分析。每项指标又设2～3个不同的量化亚组进行比较。结果筛选出7项指标与手术预后有明显关系：术后30h内创面出血（B0．356，P=0．000），出血量〉2I．被评为3分；肝脏体积（B=0．160，P=0．000），重度肝萎缩（hi肝前后径≤55mm、右肝斜径≤110mm）被评为3分；血液pH（B0．141，P=0．000），pH〈7．35被评为2分；剩余碱（BE）（B=0．123，P=0．000），〈-3mmol／I。被评为2分；血小板（PLT）减少（B0．065，P=0．015），〈3×10^9／L被评为2分；术中创面出血（B0．062，P=0．014），出血量〉2L被评为2分；红细胞减少（B0．053，P=0．024），〈3g／L被评为1分。治愈好转组147例，除1例总分为4分外，其余病例均≤3分；死亡组14例，除1例总分为4分外，其余病例均≥5分。结论术后创面大出血、肝脏重度萎缩、血液pH值〈7．35，BE〈3mmol／L、PIT下降、术中创面大出血，红细胞减少是手术预后的危险因素。总分5～6分手术有死亡可能；总分≥8分应列为手术禁忌。要降低死亡率，术前应积极治疗，将总分控制在4分以内。Objective To investigate the prognostic risk factors for surgery in patients with cirrhotic portal hypertension. Methods One hundred and sixty one patients with cirrhotic portal hyper tension who received surgery in our hospital in the past 10 years were studied. The data were entered into a pre-designed form. 24 predictors including patients＇ age, sex, degree of liver atrophy, ChildPugh classification, coagulation profile, splenic size, renal function, blood pH, base excess （BE）, op erative time, volume of aseites, and intraoperative and postoperative hemorrhage were recorded and analyzed. For each of the predictors, 2-3 subgroups were compared. Results Seven predictors were clearly related to surgical prognosis： postoperative bleeding within 30h （B0. 356, P〈0. 001） and a bleeding volume〉2 L were awarded 3 points; liver volume （B=0. 160, P〈0. 001） and severe liver atrophy （antero-posterior diameter of the left liver lobe 455 mm, oblique diameter of the right lobe ≤110 mm） were awarded three points; blood pH （B0. 141, P〈0.001）, pH〈7.35 was awarded 2 points; BE （B=0. 123 , P〈0.001）, BE〈-3 （retool/L） was awarded 2 points; decrease in PLT （B0.065, P=0.015）, PLT〈3（T/L） was awarded 2 points; intraoperative bleeding （B0.062, P=0.014）, bleeding volume 〉2 L was awarded 2 points; decrease in RBC （B0.053, P=0.024）, 〈3（G/L） was awarded 1 point. Of the 147 patients who recovered from surgery, all had 43 points, except one who had 4 points. Of the 14 patients who died, all had ≥5 points except one who had 4 points. Conclusions Postoperative bleeding （〉2 L）, severe liver atrophy （antero-posterior diameter of the left live lobe 455 m, oblique diameter of the right lobe ≤110 mm）, blood PHi7.35, BE 〈-3 （mmol/L）, PLT〈30 000（T/L）, intraoperative major bleeding （〉2 L） and RBC〈3 （G/L） were significant prognostic risk factors for surgery. For patients who had a score of 5-6 points; death was likely following surgery. A score

关 键 词：肝硬化门静脉高压症 手术预后 危险因素 

分 类 号：R657.3[医药卫生—外科学]