肝硬化门静脉高压症术后门静脉血栓形成危险因素研究  

Risk factors of portal vein thrombosis after surgery for cirrhotic portal hypertension

作　　者：卢翔[1] 赵青川[1] 韩国宏[1] 祁兴顺[1] 

机构地区：[1]第四军医大学西京消化病医院胃肠外科,陕西西安710032

出　　处：《中国实用外科杂志》2013年第3期205-207,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨手术治疗肝硬化门静脉高压症术后门静脉血栓(portal vein throm bosis,PVT)发生的危险因素。方法回顾性分析第四军医大学西京消化病医院胃肠外科2008年3月至2010年8月采用脾肾分流术加贲门周围血管离断联合手术和脾切除加贲门周围血管离断联合术治疗87例肝硬化门静脉高压症的临床资料。结果肝硬化门静脉高压症病人术后PVT发生率为17.24%(15/87),其中脾切除加贲门周围血管离断联合术血栓发生率为19.70%(13/66),脾肾分流术加贲门周围血管离断联合手术后血栓发生率为9.52%(2/21)。单因素分析结果显示术后门静脉主干直径增宽、血流流速减缓、门静脉压力增高、D-二聚体和胆固醇升高与PVT发生相关(P<0.05)。Logistic回归多因素分析结果显示D-二聚体(OR=8.083,P=0.014)与胆固醇水平(OR=5.888,P=0.017)是预测术后PVT形成的独立危检因素。结论监测D-二聚体与胆固醇水平对预测术后PVT形成有重要意义。Objective To study the risk factors of portal vein thrombosis （PVT） after surgery for cirrhotic portal hypertension. Methods The clinical data of 87 consecutive patients received splenorenal shunt combined with devascularization or splenectomy combined with devascularization between March 2008 and August 2010 in Xijing Hospital of Digestive Disease, Fourth Military Medical University were analyzed retrospectively. Results The overall incidence of PVT was 17.24% （15/87）. In patients performed splenectomy combined with devascularization and performed splenorenal shunt combined with devascularization, the incidence was 19.70% （13/66） and 9.52% （2/21） respectively. Wider portal vein diameter, slower portal blood flow, increased portal vein pressure, higher levels of D-dimer and cholesterol were correlated with the incidence of PVT positively in the univariate analyze （all P〈0.05）. No significant difference of age, sex, Child-Pugh class, fibrinogen, prothrombin time and platelets count between patients with and without PVT was detected. Multivariate analysis demonstrated that increased levels of D-dimer （OR=8.083, P= 0.014） and cholesterol （OR=5.888, P=0.017） were independent risk factors of PVT after surgery. Conclusion Higher levels of D-dimer and cholesterol indicate a higher incidence of PVT after surgery for cirrhotic portal hypertension. It is necessary to detect the level of D-dimer and cholesterol for the prevention of PVT.

关 键 词：肝硬化 门静脉高压 脾肾静脉分流术 血流动力学 门静脉血栓形成 危险因素分析 

分 类 号：R6[医药卫生—外科学]