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肝硬化门静脉高压脾切除术后门静脉血栓形成的预测因素分析
Predictive factors for portal vein thrombosis after splenectomy in cirrhotic patients with portal hypertension
文章发布日期:2017年12月09日  来源:  作者:牟思玉,杨哲,吴力群,等  点击次数:123次  下载次数:13次

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【摘要】:目的 探讨肝硬化门静脉高压患者接受脾切除断流术后门静脉血栓形成的原因。方法 回顾性分析2012年1月-2016年8月青岛大学附属医院收治的123例脾切除断流术后患者临床资料,根据术后门静脉血栓发生与否分为血栓组与非血栓组。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。采用logistic回归模型进行多因素分析,受试者工作特征曲线下面积(AUC)比较影响因素预测价值。结果 37例脾切除断流术后患者发生门静脉血栓,发生率为30.08%。血栓组与非血栓组单因素分析结果显示,术前BMI(t=2.291)、MELD评分(t=1.852)、门静脉直径(t=1.982)、脾静脉直径(t=2.582)、肠系膜上静脉直径(t=2.186)、脾静脉流速(t=2.109)、脾蒂切除方式(χ2=4.505)比较,差异均有统计学意义(P值均<0.05);肝功能Child-Pugh A级患者血栓组与非血栓组比较显示,脾静脉直径、肠系膜上静脉直径、门静脉直径、术前BMI组间差异有统计学意义(t值分别为2.347、2.654、2.312、2.187,P值均<0.05)。多因素logistic回归分析显示,BMI[比值比(OR)=0.859,95%可信区间(95%CI):0.750~0.983,P=0.027]、脾静脉直径(OR=1.191,95%CI:1.035~1.370,P=0.015)、脾静脉流速(OR=1.125,95%CI:1.004~1.262,P=0.043)、肠系膜上静脉直径(OR=1.202,95%CI:1.001~1.444,P=0.048)、Ⅰ级脾蒂切除(OR=2.815,95%CI:1.056~7.503,P=0.039)是术后门静脉血栓形成的独立危险因素。术前BMI<22.54 kg/m2(敏感度75.9%,特异度58.3%)或术前脾静脉直径>11.50 mm(敏感度72.7%,特异度62.9%)时,提示脾切除断流术后更容易形成门静脉血栓。结论 术前脾静脉直径、BMI与术后门静脉血栓形成有关,针对二者监测可能有助于早期预测门静脉血栓形成。
【Abstract】:Objective To investigate the cause of portal vein thrombosis (PVT) after esophagogastric devascularization and splenectomy in cirrhotic patients with portal hypertension (PH). Methods A retrospective analysis was performed for the clinical data of 123 patients who were admitted to The Affiliated Hospital of Qingdao University from January, 2012 to August, 2016 and underwent esophagogastric devascularization and splenectomy, and according to the presence or absence of PVT after surgery, these patients were divided into PVT group and non-PVT group. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The logistic regression model was used for multivariate analysis, and the area under the curve (AUC) was used to compare the predictive value of influencing factors. Results Of all patients, 37 experienced PVT after esophagogastric devascularization and splenectomy, resulting in an incidence rate of 30.08%. The univariate analysis of the PVT group and the non-PVT group showed that there were significant differences between the two groups in preoperative body mass index (BMI) (t=2.291, P<0.05), Model for End-Stage Liver Disease (MELD) score (t=1.852, P<0.05), portal vein diameter (t=1.982, P<0.05), splenic vein diameter (t=2.582, P<0.05), superior mesenteric vein diameter (t=2.186, P<0.05), flow rate of the splenic vein (t=2.109, P<0.05), and method for the resection of the splenic pedicle (χ2=4.505, P<0.05). As for Child-Pugh class A patients, there were significant differences between the PVT group and the non-PVT group in splenic vein diameter, superior mesenteric vein diameter, portal vein diameter, and preoperative BMI (t=2.347, 2.654, 2.312, and 2.187, all P<0.05). The multivariate logistic regression analysis showed that BMI (odds ratio [OR]=0.859, 95% confidence interval [CI]: 0.750-0.983, P=0.027), splenic vein diameter (OR=1.191, 95%CI: 1.035-1.370, P=0.015), flow rate of the splenic vein (OR=1.125, 95%CI: 1.004-1.262, P=0.043), superior mesenteric vein diameter (OR=1.202, 95%CI: 1.001-1.444, P=0.048), and primary splenic pedicle resection (OR=2.815, 95%CI: 1.056-7.503, P=0.039) were independent risk factors for PVT after surgery. Preoperative BMI <22.54 kg/m2 (sensitivity 75.9% and specificity 58.3%) or preoperative splenic vein diameter >11.5 mm (sensitivity 72.7% and specificity 62.9%) suggested a higher risk of PVT after esophagogastric devascularization and splenectomy. Conclusion Preoperative splenic vein diameter and BMI are associated with PVT after surgery, and monitoring of these two indices helps to predict PVT in the early stage.
【关键字】:高血压,门静脉;脾切除术;静脉血栓形成;危险因素
【Key words】:hypertension, portal; splenectomy; venous thrombosis; risk factors
【引证本文】:MU SY, YANG Z, WU LQ, et al. Predictive factors for portal vein thrombosis after splenectomy in cirrhotic patients with portal hypertension[J]. J Clin Hepatol, 2018, 34(1): 106-111. (in Chinese)
牟思玉, 杨哲, 吴力群, 等. 肝硬化门静脉高压脾切除术后门静脉血栓形成的预测因素分析[J]. 临床肝胆病杂志, 2018, 34(1): 106-111.

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