贲门周围血管离断术后并发症发生的影响因素分析  

Influencing factors analysis for the incidence of postoperative complications after pericardical devascularization

作　　者：刘阳[1] 赵耀[1] 黎一鸣[1] 陈熹[1] 刘清峰[1] Liu Yang Zhao Yao Li Yiming Chen Xi Liu Qingfeng.(Department of General Surgery, the Second Affiliated Hospital of Xi＇an diaotong University School of Medicine, Xi＇an 710061, China)

机构地区：[1]西安交通大学医学院第二附属医院普通外科,71004

出　　处：《中华肝脏外科手术学电子杂志》2017年第4期266-269,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨贲门周围血管离断术后并发症发生的影响因素及其对患者远期生存的影响。方法回顾性分析2009年9月至2012年9月在西安交通大学医学院第二附属医院行贲门周围血管离断术的268例门静脉高压症患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男160例,女108例;年龄22~77岁,中位年龄47岁;均行脾切除+贲门周围血管离断术。根据患者术后是否发生并发症分为并发症组(57例)和无并发症组(211例)。比较两组围手术期资料,并对患者的生存进行随访。两组临床资料比较采用t检验或Wilcoxon秩和检验,率的比较采用χ~2检验。结果并发症组既往总出血量>1 000 ml及有内镜下治疗史患者百分率分别为51%(29/57)、26%(15/57),明显高于无并发症组的29%(61/211)、12%(26/211)(χ~2=8.749,6.781;P<0.05)。并发症组ALT、AST、PT分别为35(22)U/L、50(31)U/L、(14.1±1.7)s,明显高于无并发症组的26(21)U/L、37(22)U/L、(13.5±1.6)s(Z=2.691,Z=3.063,t=2.479;P<0.05)。随访期间并发症组死亡6例,无并发症组11例,两组患者生存率比较差异无统计学意义(χ~2=1.008,P>0.05)。并发症组发生肝细胞癌3例,无并发症组5例,截止投稿日期患者均带瘤生存。结论术前大出血、内镜下治疗史、肝功能和凝血功能较差是贲门周围血管离断术后并发症发生的影响因素,但术后并发症的发生并不影响患者远期生存。Objective To investigate the influencing factors for the incidence of postoperative complications after pericardical devascularization and evaluate its effect upon the long-term survival of the patients. Methods Clinical data of 268 patients with portal hypertension who underwent pericardical devascularization in the Second Affiliated Hospital of Xi＇an Jiaotong University School of Medicine between September 2009 and September 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among the patients, 160 cases were males and 108 were females, aged 22-77 years old with a median age of 47 years old. The patients all underwent splenectomy ＋ pericardical devascularization. According to the postoperative complications happened or not, the patients were divided into the complication group （n=57） and non-complication group （n=211）. The perioperative data of two groups were compared and the postoperative survival was followed up. The clinical data of two groups were compared using t test or Wilcoxon rank sum test. The rate was compared using Chi-square test. Results The percentage of patients with medical history of total blood loss 〉1 000 ml and endoscopic treatment in the complication group was respectively 51%（29/57） and 26%（15/57）, significantly higher than 29%（61/211） and 12%（26/211） in the non-complication group （23=8.749, 6.781; P〈0.05）. The level of ALT, AST and PT in the complication group was respectively 35（22） U/L, 50（31） U/L and （14.1-4-1.7） s, significantly higher than 26（21） U/L, 37（22） U/L and （13.5＋1.6） s in the non-complication group （Z=2.691, Z=3.063, t=2.479; P〈0.05）. During postoperative follow-up, 6 patients died in the complication group and 11 in the non-complication group. There was no significant significance in the survival rate between two groups （χ2=1.008, P〉0.05）. Three cases of hepatocellular carcinoma occurred in the complication

关 键 词：断流术 脾切除术 高血压 门静脉 手术后并发症 危险因素 

分 类 号：R657.34[医药卫生—外科学]