肝硬化门静脉高压脾切断流术后影响门静脉系统血栓形成的因素  

Influential factors for portal venous thrombosis after splenectomy and gastric pericardial devascularization for cirrhotic portal hypertension

作　　者：陈小刚[1] 张培瑞[2] 李志伟[2] 齐瑞兆[2] 余灵祥[2] 张绍庚[1] 

机构地区：[1]福建医科大学福州总医院临床医学院肝胆外科,福建福州350025 [2]解放军第三〇二医院肝胆外科,北京100039

出　　处：《中国普通外科杂志》2013年第1期67-70,共4页China Journal of General Surgery

摘　　要：目的:探讨脾切断流术后门静脉血栓形成(PVT)的危险因素及防治方法。方法:回顾性分析12年间1 300例行脾切除+贲门周围血管离断术治疗肝硬化门静脉高压患者的临床资料,观察其术后PVT形成情况,并对术后PVT形成的因素进行分析。结果:全组术后PVT发生率为30.15%(392/1 300);PVT形成与患者年龄、合并糖尿病、食管胃底静脉曲张程度、肝功能分级、D-二聚体、脾脏大小、是否抗凝治疗等因素有关(均P<0.05),而与患者性别、手术时间和术中出血量无关(均P>0.05)。结论:年龄、肝脏功能、门静脉压力、食管胃底静脉曲张、合并糖尿病、巨脾等是脾切断流术后PVT形成的影响因素;应用抗凝治疗可降低术后PVT的发生率。Objective： To investigate the influential factors and prophylactic methods for portal venous thrombosis （PVT） after splenectomy and gastric pericardial devascularization. Methods： The clinical data of 1 300 patients with cirrhotic portal hypertension undergoing splenectomy and gastric pericardial devascularization over 12 years were reviewed. The incidence of PVT after operation was observed and the influential factors for PVT were analyzed. Results： The incidence of PVT after operation in the entire group was 30.15% （392/1 300）. Statistical analysis showed that the postoperative PVT was associated with patients＇ age, concomitant diabetes, degree of esophagogastric varices, hepatic function grade, portal pressure, D-dimer level and spleen size as well as whether they received anticoagulant therapy （all P〈0.05）, but it was irrelevant to the sex, operative time and intraoperative blood loss of the patients （all P〉0.05）.Conclusion： Age, liver function, portal pressure, concomitant diabetes and spleen size are the influential factors for PVT following splenectomy and gastric pericardial devascularization, and anticoagulant therapy may reduce the incidence of postoperative PVT.

关 键 词：高血压 门静脉 外科学 血栓形成 门静脉 治疗 脾切除术 

分 类 号：R657.34[医药卫生—外科学]