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门静脉高压患者脾切断流术后曲张静脉再出血的危险因素分析
Risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension
文章发布日期:2018年09月10日  来源:  作者:赵晓飞,林栋栋,李宁,等  点击次数:527次  下载次数:41次

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【摘要】:目的分析门静脉高压患者脾切断流术后影响曲张静脉再出血的相关因素。方法回顾性分析北京佑安医院2010年4月-2015年9月收治的244例门静脉高压行脾切断流术患者的临床资料,根据曲张静脉是否再出血分为未出血组和再出血组。对比分析两组术前、术中及术后临床资料。正态分布的计量资料组间比较采用t检验,非正态分布数据组间比较采用Wilcoxon秩和检验,计数资料组间比较采用χ2检验。将单因素分析结果具有统计学意义的变量进行logistic多因素回归分析。结果244例患者中38例(15.6%)出现曲张静脉再出血。单因素分析显示,两组患者在曲张静脉出血史、术前腹水、术后TBil、断流后门静脉压力、切脾前门静脉压力、切脾后门静脉压力、术前INR等方面的差异具有统计学意义(χ2值分别为5530、4120,t值分别为3591、4098、2516、2622、4278,P值分别为0.016、0.026、0.008、0.002、0.022、0012、0.003)。多因素logistic回归分析结果显示,患者的曲张静脉破裂出血史(95%可信区间:1113~13704,P=0.033)、术前腹水(95%可信区间:1257~5437,P=0.010)以及断流后门静脉压力(95%可信区间:1022~1172,P=0.010)是脾切断流术后曲张静脉再出血的独立危险因素。结论曲张静脉破裂出血史、术前腹水以及断流后门静脉压力是临床医生评估脾切断流术后再出血风险的重要依据。
【Abstract】:ObjectiveTo investigate the risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 244 patients with portal hypertension who were admitted to Beijing YouAn Hospital from April 2010 to September 2015 and underwent esophagogastric devascularization and splenectomy. According to the presence or absence of variceal rebleeding, these patients were divided into non-rebleeding group and rebleeding group. Preoperative, intraoperative, and postoperative clinical data were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for statistically significant variables identified by the univariate analysis. ResultsOf all 244 patients, 38 (15.6%) experienced variceal rebleeding. The univariate analysis showed that there were significant differences between the two groups in the history of variceal bleeding, preoperative ascites, total bilirubin after surgery, portal venous pressure after devascularization, portal venous pressure before and after splenectomy, and preoperative international normalized ratio (χ2=5530、4120,t=3591、4098、2516、2622、4278,P=0.016, 0.026, 0.008, 0.002, 0022, 0.012, and 0.003). The multivariate logistic regression analysis showed that variceal rebleeding after esophagogastric devascularization and splenectomy was associated with the history of variceal bleeding (95%CI:1113-13704,P=0.033), preoperative ascites (95%CI:1257-5437,P=0.010), and portal venous pressure after devascularization (95%CI:1022-1172,P=0.010). ConclusionHistory of variceal bleeding, preoperative ascites, and portal venous pressure after devascularization are independent risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy.
【关键字】:肝硬化; 高血压, 门静脉; 食管和胃静脉曲张; 脾切除术
【Key words】:liver cirrhosis; hypertension, portal; splenectomy; esophageal and gastric varices
【引证本文】:ZHAO XF, LIN DD, LI N, et al. Risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension[J]. J Clin Hepatol, 2018, 34(10): 2182-2185. (in Chinese)
赵晓飞, 林栋栋, 李宁, 等. 门静脉高压患者脾切断流术后曲张静脉再出血的危险因素分析[J]. 临床肝胆病杂志, 2018, 34(10): 2182-2185.

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