贲门周围血管离断术后门静脉血栓形成的预测因素分析  

Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization

作　　者：匡洁[1] 杨卫平[1] 严佶祺[1] 马迪[1] 陈皓[1] 彭承宏[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中国普外基础与临床杂志》2015年第11期1305-1309,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：卫生部行业科研专项项目(编号:201002015)~~

摘　　要：目的探讨肝硬变门静脉高压症行脾切除加贲门周围血管离断术（以下简称＂离断术＂）术前（1周内）及术后第1 d相关因素对预测其术后门静脉血栓形成的价值。方法回顾性分析2014年1月至2015年6月期间因肝硬变门静脉高压症在我院行离断术的61例患者的临床资料,根据术后第7 d时的门静脉多普勒超声检查结果分为血栓组和非血栓组。分析可能与门静脉血栓形成的相关因素,如术前及术后第1 d的血常规、肝功能、7项凝血功能（部分活化凝血酶原时间、凝血酶原时间、国际标准化比率、凝血酶时间、纤维蛋白原、纤维蛋白降解产物、D-二聚体）、门静脉的直径、流速、流量以及切脾前及断流术后自由门静脉压力。结果术后第7 d时血栓组25例,非血栓组36例。单因素分析结果显示,术前血小板计数在血栓组中明显低于非血栓组（P=0.006）,术前部分活化凝血酶原时间（P=0.048）、凝血酶原时间（P=0.028）、国际标准化比率（P=0.029）在血栓组中明显高于非血栓组,血栓组术后纤维蛋白降解产物（P=0.002）和D-二聚体（P=0.014）明显高于非血栓组,血栓组的门静脉直径比非血栓组大（P=0.050）。进一步行多因素logistic回归分析,术前血小板计数（OR=0.966,95%CI为0.934~1.000,P=0.048）和术后纤维蛋白降解产物（OR=1.055,95%CI为1.011~1.103,P=0.017）与术后门静脉血栓形成相关。当术前血小板计数〈34.5×109/L（敏感度80.6%,特异度60.0%）或术后第1 d纤维蛋白降解产物〉64.75 mg/L（敏感度48.0%,特异度91.7%）时,提示离断术后更容易形成门静脉血栓。结论术前血小板及术后第1 d纤维蛋白降解产物与术后门静脉血栓形成有关,监测上述指标可能有助于早期预测术后门静脉血栓形成。Objective To investigate the predictive factors of portal vein thrombosis（PVT） before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.Methods Sixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively.The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7.The clinical factors related with PVT were analyzed.Results There were 25 cases in the DVT group and 36 cases in the non-DVT group.The results of univariate analysis showed that the preoperative platelet（P=0.006）,activated partial thromboplastin time（P=0.048）,prothrombin time（P=0.028）,and international normalized ratio（P=0.029）,postoperative fibrin degradation product（P=0.002） and D-dimer（P=0.014） on day 1,portal venous diameter（P=0.050） had significant differences between the DVT group and non-DVT group.The results of logistic multivariate regression analysis showed that the preoperative platelet（OR=0.966,95%CI 0.934- 1.000,P=0.048） and postoperative fibrin degradation product on day 1（OR=1.055,95%CI 1.011- 1.103,P=0.017） were correlated with the PVT.The PVT might happen when preoperative platelet was less than 34.5×10~9/L（sensitibity 80.6%,specificity 60.0%）or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L（sensitibity 48.0%,specificity 91.7%）.Conclusion Preoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.

关 键 词：门静脉高压症 脾脏切除 贲门周围血管离断术 门静脉血栓 预测 血小板 纤维蛋白降解产物 

分 类 号：R657.3[医药卫生—外科学]