P-选择素对腹腔镜脾切除术后门静脉血栓形成的早期预测价值  

Early predictive values of P-selectin for portal vein thrombosis after laparoscopic splenectomy

作　　者：魏云海[1] 尹磊 王雁[1] 沈华[1] 慎华平[1] 吴万波[1] 陈文显[1] WEI Yun-hai;YIN Lei;WANG Yan(Department of General Surgery,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]湖州市中心医院,浙江湖州313000

出　　处：《腹腔镜外科杂志》2018年第12期927-930,共4页Journal of Laparoscopic Surgery

基　　金：浙江省科技厅公益性技术应用研究计划项目(编号:2014C33137)

摘　　要：目的:探讨P-选择素对腹腔镜脾切除术后门静脉血栓形成的早期预测价值。方法:收集2009年～2017年因肝硬化门静脉高压症而行腹腔镜脾切除术的48例患者的临床资料,术后根据多普勒血管彩超诊断结果分为血栓组与非血栓组。动态监测两组患者术前第1天及术后第1天、第3天、第5天、第7天、第14天的P-选择素、血栓前体蛋白、血小板及D-二聚体值,并进行统计学分析。结果:术前两组患者四项指标水平差异无统计学意义(P>0.05)。血栓组P-选择素、D-二聚体、血栓前体蛋白于第1天即出现峰值,且明显高于非血栓组,差异有统计学意义(P<0.05),之后开始缓慢下降。相较其他指标,P-选择素于术后第5天P值仍小于0.001,维持时间最长。术后第1天,四项指标中P-选择素的门静脉血栓形成阳性预测值及诊断率均高于D-二聚体、血小板、血栓前体蛋白,且误诊率及漏诊率最低。结论:P-选择素对腹腔镜脾切除术后门静脉血栓的形成具有早期预测价值,可作为临床监测的有效指标。Objective:To investigate the early predictive value of P-selectin(P-sel)for portal vein thrombosis after laparoscopic splenectomy.Methods:Overall 48 patients with liver cirrhosis complicating with portal hypertension who underwent laparoscopic splenectomy were recruited from Jan.2009 to Dec.2017.Postoperatively,patients were divided into thrombotic group and non-thrombotic group according to the diagnostic results of Doppler ultrasonography.The P-sel,thrombus precursor protein(TpP),platelet(PLT)and D-dimer(D-D)levels in the two groups were dynamically monitored on preoperative day 1 and postoperative day 1,3,5,7,14.Results:There were no significant differences in levels of these detection indexes between the two groups before surgery(P>0.05).The P-sel,D-D and TpP in the thrombotic group peaked in the postoperative first day,and were significantly higher than those in the non-thrombotic group(P<0.05),and then were gradually reduced as the time process.Compared with other indexes,the P-sel value was still significantly different on the 5th day after surgery,and the maintenance time of P<0.001 was the longest.The positive predictive value and diagnostic rate of P-sel was higher than that of D-D,PLT and TpP,and the rate of misdiagnosis and missed diagnosis was the lowest.Conclusions:P-sel has early predictive value for portal vein thrombosis after laparoscopic splenectomy and can be used as an effective indicator of clinical monitoring.

关 键 词：P选择素 门静脉血栓形成 脾切除术 腹腔镜检查 预测 

分 类 号：R657.6[医药卫生—外科学]