脾肾静脉分流联合贲门周围血管离断术后肝功能不全的危险因素分析  

Risk factors of postoperative liver dysfunction in cirrhotics after splenorenal shunt and esophagogastrlc devaseularization

作　　者：王晓斌 谢军红 吕越明 

机构地区：[1]张掖市甘州区人民医院普外科,甘肃省734000

出　　处：《中华普通外科杂志》2017年第9期770-773,共4页Chinese Journal of General Surgery

摘　　要：目的探讨肝功能Child—PughA级肝硬化患者行脾肾静脉分流加贲门周围血管离断术后肝功能不全的危险因素。方法选取2014年11月至2016年11月收治的128例术前肝功能Child—PughA级（包括评分5和6）的肝硬化患者，均接受脾肾静脉分流加贲门周围血管离断术，分析术后肝功能不全的危险因素。结果纳入研究的肝硬化患者128例在脾肾静脉分流术加贲门周围血管离断术后发生肝功能不全的患者共有22例，其发生率为17．2％。年龄、既往上消化道出血病史、腹水、血清前白蛋白、术前白蛋白、术后通气时间≥3d及术后白蛋白与术后肝功能不全有关，差异有统计学意义（P〈0．01）。而年龄≥60岁、血清前白蛋白〈170g/L及术前白蛋白〈30g／L是术后发生肝功能不全的独立危险因素。结论年龄≥60岁、血清前白蛋白〈170g／L及术前白蛋白〈30g／L是术前肝功能Child—PughA级的肝硬化患者行脾肾静脉分流术加贲门周围血管离断术后发生肝功能不全的独立危险因素。Objective To explore the risk factors of postoperative liver dysfunction in cirrhotic patients with Child-Pugh A liver function after splenorenal shunt and esophagogastric devascularization. Methods 128 Child-Pugh A cirrhotics undergoing splenorenal shunt and portal-azygous disconnection in our hospital from February, 2014 to February, 2016 were evaluated for risk factors of postoperative liver dysfunction. Results 22 cases （17.2%） developed postoperative liver dysfunction. By single factor analysis, age, history of upper gastrointestinal hemorrhage, ascites, serum prealbumin, serum albumin, mechanical ventilation time after surgery, postoperative serum albumin were associated with postoperative liver dysfunction. Non-conditional Logistic regression showed that age 〉 60, serum prealbumin 〈 170 g/L and serum albumin 〈 30 g/L was independent risk factors for postoperative liver dysfunction. Conclusion Patients＇ age 〉 60, serum prealbumin 〈 170 g/L and serum albumin 〈 30 g/L was independent risk factors for postoperative liver dysfunction after splenorenal shunt and portal-azygous disconnection.

关 键 词：肝硬化 脾.肾分流术 外科 贲门周围血管离断术 

分 类 号：R657.3[医药卫生—外科学]