血浆D-二聚体对腹腔镜脾切除门奇静脉断流术后门静脉血栓形成的预测意义  

Significance of D-dimer in predicting portal vein thrombosis after laparoscopic splenectomy and esophagogastric devascularization

作　　者：李大伟[1] 

机构地区：[1]浙江省中医院普通外科,浙江杭州310018

出　　处：《中国普通外科杂志》2014年第2期207-211,共5页China Journal of General Surgery

摘　　要：目的:探讨血浆D-二聚体(D-dimer,D-D)水平对肝炎后肝硬化门脉高压症患者行腹腔镜脾切除门奇静脉断流术(LSED)后门静脉系统血栓形成(PVT)的预测意义。方法:选择47例因肝炎后肝硬化门脉高压症行LSED患者,测定患者术前与术后1、7、14 d的血浆D-二聚体水平及凝血功能指标;术后7、14 d行彩超检查明确有无PVT;对D-二聚体水平的LSED后PVT诊断效能行接收者工作特征曲线(ROC)分析。结果:47例患者中有21例于术后发生PVT。PVT组与非PVT组患者LSED后血浆D-二聚体水平均持续升高,但PVT组术后7、14 d的D-二聚体水平均明显高于非PVT组(P<0.05);两组患者凝血酶原时间(PT),凝血酶时间(TT),活化部分凝血活酶时间(APTT)手术前后无明显变化,且两组间差异无统计学意义(P>0.05),两组血小板(PLT)水平均较术前升高(P<0.05),但两组间差异无统计学意义(P>0.05)。术后7 d血浆D-二聚体水平对LSED后PVT诊断准确性的ROC曲线下面积(AUC)为0.7 801(P<0.05)。结论:肝炎后肝硬化门脉高压症患者行LSED术后血浆D-二聚体水平升高,术后血浆D-二聚体持续较高水平(≥14 mg/L)者,发生PVT的危险性较大,应加强血栓监测及抗凝预防。Objective： To assess the significance of the plasma D-dimer （D-D） level in predicting portal vein thrombosis （PVT） after laparoscopic splenectomy and esophagogastric devascularization （LSED） in patients with portal hypertension secondary to posthepatitic cirrhosis. Methods： Forty-seven patients with portal hypertension caused by posthepatitic cirrhosis scheduled for LSED were enrolled. The plasma D-dimer levels and coagulation function parameters of the patients before and at 1,7 and 14 d after surgery were determined, color Doppler ultrasonography was performed on postoperative day （POD） 7 and 14 for PVT, and receiver operating characteristic curve （ROC） analysis was performed to determine the diagnostic efficiency of D-dimer level for post-LSED PVT. Results： Twenty-one of 47 patients developed PVT after LSED. The D-dimer levels in both PVT group and non-PVT group continued to rise after surgery, but the D-dimer levels in PVT group on POD 7 and 14 were significantly higher than those in non-PVT group （P〈0.05）. The prothrombin time PT, thrombin time （TT）, and activated partial thrombin time （APTF） showed no obvious change before and after surgery in both PVT group and non-PVT group, and also showed no statistical difference between the two groups （P〉0.05）. The postoperative platelet （PLT） counts in both groups were increased compared with their preoperative levels, but showed no statistical difference between the two groups （P〉0.05）. The area under the ROC curve （AUC） reflecting the predictive accuracy of the D-dimer level on POD 7 for post-LSED PVT was 0.7 801 （P〈0.05）. Conclusion： Plasma D-dimer level is increased after LSED in patients with portal hypertension caused by posthepatitic cirrhosis, and the risk of PVT is increased in patients whose post-LSED plasma D-dimer sustains a high level （〉14 mg/L）, for whom, thrombus monitoring and preventive anticoagulation should beenhanced.

关 键 词：高血压 门静脉 脾切除术 腹腔镜 D-二聚体 静脉血栓形成 

分 类 号：R675.3[医药卫生—外科学]