不同病因行脾切除术后门静脉血栓形成情况及其相关凝血功能指标变化分析  

Situation of portal vein thrombosis and related coagulation function indicators analysis after splenectomy due to different etiologies

作　　者：黄苠杰 赵强 李秋 HUANG Minjie;ZHAO Qiang;LI Qiu(Department of Hepatopancreatobiliary Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China)

机构地区：[1]西南医科大学附属医院肝胆胰外科,四川泸州646000

出　　处：《中国普外基础与临床杂志》2024年第8期968-975,共8页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的分析因不同病因行脾切除术后患者的血小板、凝血功能及门静脉血栓形成(portal vein thrombosis,PVT)发生情况。方法回顾性收集2013年1月至2022年12月期间西南医科大学附属医院收治的行脾切除患者,依据其病因分为脾脏及胰腺占位行脾切除组(简称“占位组”)、门静脉高压及脾功能亢进行脾切除组(简称“脾亢组”)和外伤性脾破裂行脾切除组(简称“脾破组”)。观察3组患者术前及术后的血细胞(包括血小板、白细胞、红细胞、中性粒细胞)、凝血功能指标(包括凝血酶原时间、活化部分凝血酶时间、纤维蛋白原、D-二聚体)变化情况。结果本研究共收集到166例患者,其中占位组42例、脾亢组22例、脾破组102例,3组患者的年龄和术前Child-Pugh评分比较差异无统计学意义(P>0.05)。发生PVT患者12例(7.2%),其中占位组2例、脾亢组6例及脾破组4例,3组患者PVT发生率总体比较差异有统计学意义(Fisher确切概率法,P=0.003),脾亢组高于占位组(P=0.016)和脾破组(P=0.002),而占位组与脾破组比较差异无统计学意义(P=1.000)。总体趋势是,3组不同病因脾切除患者术后的血小板、血细胞(除红细胞)以及各凝血功能指标(凝血酶原时间、活化部分凝血酶时间、纤维蛋白原)均在术后开始呈上升趋势,但各组术后达峰时间和术后变化趋势差异较大。发生和未发生PVT组患者在观察期内PLT计数随时间而改变(未发生PVT组:F=60.238,P<0.001;发生PVT组:F=9.700,P=0.043),即2组患者术后均呈持续上升趋势,至第14天时均达峰值后开始呈下降趋势,但2组间的组间效应无统计学意义(F=0.056、P=0.816)。结论本研究结果提示,脾亢组与其余2组相比,血小板升高峰值更低,更易形成PVT,而并未发现未发生和发生PVT患者的血小板水平的差异。Objective To analyze the platelet(PLT)count,coagulation function,and portal vein thrombosis(PVT)in the patients underwent splenectomy due to different etiologies.Methods The patients who underwent splenectomy in the Affiliated Hospital of Southwest Medical University from January 2013 to December 2022 were collected.According to the etiology,the patients were assigned into the occupying group(splenic and pancreatic occupying lesions),hypersplenism group(portal hypertension and hypersplenism),and splenic rupture group(traumatic splenic rupture).The changes of PLT,white blood cells(WBC),red blood cells(RBC),neutrophils(Neut),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),D-dimer(DD),and PVT were observed after splenectomy.Results A total of 166 patients were collected,including 42 in the occupying group,22 in the hypersplenism group,and 102 in the splenic rupture group.There were no statistically significant differences in the age and preoperative Child-Pugh score among the patients of the three groups(P>0.05).There were 12(7.2%)patients with PVT,including 2 in the occupying group,6 in the hypersplenismn group,and 4 in the splenic rupture group.The PVT incidence among the three groups had a statistical significant difference(Fisher exact test,P=0.003),which in the hypersplenismn group was higher than the occupying group(P=0.016)and the splenic rupture group(P=0.002),while there was no statistically significant difference between the occupying group and the splenic rupture group(P=1.000).The overall trend was that the PLT,RBC,WBC,and various coagulation function indicators such as PT,APTT,and Fib among the three groups all showed an upward trend immediately after splenectomy,but the postoperative peak time and change trends had no markedly regular among the three groups.The PLT of the patients with and without PVT changed over time during the observation period(patients without PVT:F=60.238,P<0.001;patients with PVT group:F=9.700,P=0.043),and which showed a continuous upward trend a

关 键 词：门静脉高压 脾破裂 脾切除 脾功能亢进 血小板 门静脉血栓形成 

分 类 号：R657.6[医药卫生—外科学]