切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 184 -188. doi: 10.3877/cma.j.issn.1674-0793.2020.03.005

所属专题: 文献

论著

肝硬化门静脉高压症脾切除术后门静脉系统血栓形成相关因素分析
宋子敏1, 徐锋1, 杨纯博1, 冯含昕1, 戴朝六1,()   
  1. 1. 110004 沈阳,中国医科大学附属盛京医院肝胆脾外科
  • 收稿日期:2019-08-05 出版日期:2020-06-01
  • 通信作者: 戴朝六
  • 基金资助:
    辽宁省重点研发计划指导计划项目(2017225032); 沈阳市科技计划人口与健康专项项目(17230916)

Risk factors of portal vein thrombosis after splenectomy with liver cirrhosis ralated portal hypertension

Zimin Song1, Feng Xu1, Chunbo Yang1, Hanxin Feng1, Chaoliu Dai1,()   

  1. 1. Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China
  • Received:2019-08-05 Published:2020-06-01
  • Corresponding author: Chaoliu Dai
  • About author:
    Corresponding author: Dai Chaoliu, Email:
引用本文:

宋子敏, 徐锋, 杨纯博, 冯含昕, 戴朝六. 肝硬化门静脉高压症脾切除术后门静脉系统血栓形成相关因素分析[J/OL]. 中华普通外科学文献(电子版), 2020, 14(03): 184-188.

Zimin Song, Feng Xu, Chunbo Yang, Hanxin Feng, Chaoliu Dai. Risk factors of portal vein thrombosis after splenectomy with liver cirrhosis ralated portal hypertension[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(03): 184-188.

目的

分析肝硬化门静脉高压症(PH)脾切除术后门静脉系统血栓形成(PVST)的危险因素及预测效能。

方法

回顾性分析2011年11月至2018年12月中国医科大学附属盛京医院收治的行脾切除的278例肝硬化PH患者临床资料。

结果

患者术后PVST发生率为38.8%(108/278)。Logistic回归-ROC曲线模型显示,手术时间(AUC=0.651,95% CI:0.585~0.716)、术中输血浆量(AUC=0.615,95% CI:0.546~0.684)、术后脾静脉直径(AUC=0.665,95% CI:0.598~0.731)是影响脾切除术后PVST的独立危险因素,而术中输红细胞量(AUC=0.583,95% CI:0.514~0.651)和术后第7天TT水平(AUC=0.634,95% CI:0.568~0.699)是独立保护因素,以上指标对术后PVST都具有一定预测作用,且联合以上指标预测效能更高(AUC=0.783,95% CI:0.727~0.839)。

结论

对于肝硬化PH患者,应尽量缩短手术时间,通过围手术期适量输注红细胞和减少血浆输注预防PVST。综合考虑术后脾静脉直径和第7天TT水平因素有助于提高术后PVST的预测效能。

Objective

To analyze the risk factors of portal vein system thrombosis (PVST) after splenectomy in patients with cirrhosis of liver and portal hypertension (PH).

Methods

The clinical data of 278 patients with cirrhosis and PH who underwent splenectomy in Shengjing Hospital Affiliated to China Medical University from November 2011 to December 2018 were retrospectively analyzed.

Results

The formation rate of postoperative PVST was 38.8% (108/278). According to the Logistic regression-ROC curve model, operative time (AUC=0.651, 95% CI: 0.585-0.716), intraoperative plasma transfusion (AUC=0.615, 95% CI: 0.546-0.684), postoperative splenic vein diameter (AUC=0.665, 95% CI: 0.598-0.731) were independent risk factors for PVST formation after splenectomy. However, the intraoperative RBC transfusion (AUC=0.583, 95% CI: 0.514-0.651) and TT level on the 7 d after surgery(AUC=0.634, 95% CI: 0.568-0.699) were independent protective factors. All the above indexes had certain predictive effects on postoperative PVST formation, and the prediction efficiency of combining the above indexes was highe (AUC=0.783, 95% CI: 0.727-0.839).

Conclusions

For PH patients with liver cirrhosis, the operation time should be shortened as much as possible, and PVST may be prevented by appropriate transfusion of red blood cells and reduction of plasma transfusion during perioperative period. Combining the factors of splenic vein diameter and TT level on the 7th day is helpful to improve the prediction of PVST.

图1 血栓组与非血栓组肝硬化门静脉高压脾切除患者围手术期血小板的变化
图2 血栓组与非血栓组肝硬化门静脉高压脾切除患者围手术期D-二聚体的变化
表1 血栓组与非血栓组术前各指标比较
表2 血栓组与非血栓组术中各指标比较(例)
表3 血栓组与非血栓组术后主要指标比较结果(±s
表4 影响脾切除术后门静脉系统血栓形成的二元Logistic回归分析结果
图3 各指标预测肝硬化门静脉高压症脾切除术后门静脉系统血栓形成的ROC曲线
表5 各指标预测肝硬化门静脉高压症脾切除术后门静脉系统血栓形成的受试者工作特征曲线下面积
[1]
戴朝六, 徐锋, 金添强. 重视门静脉高压症脾切除断流术后门静脉系统血栓的诊治[J/CD]. 中华普通外科学文献(电子版), 2019, 13(3): 169-174.
[2]
张丽娟. 肝硬化门静脉高压症外科手术后门静脉血栓形成的危险因素分析[J]. 实用临床医药杂志, 2016, 20(17): 71-73, 77.
[3]
He S, He F. Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy[J]. Int J Clin Exp Med, 2015, 8(3): 4236-4242.
[4]
Maalouf M, Papasavas P, Goitein D, et al. Portal vein thrombosis after laparoscopic splenectomy for systemic mastocytosis: a case report and review of the literature[J]. Surg Laparosc Endosc Percutan Tech, 2008, 18(2): 219-221.
[5]
陈炜. 脾切除断流术后脾静脉和门静脉血栓形成的发生率为多少?是什么原因?能否预防?[J]. 外科理论与实践, 2009, 14(1): 90-91.
[6]
Manouchehri N, Kaneva P, Séguin C, et al. Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy[J]. Surg Endosc, 2016, 30(5): 2119-2126.
[7]
Huang L, Yu Q, Wang J. Association Between changes in splanchnic hemodynamics and risk factors of portal venous system thrombosis after splenectomy with periesophagogastric devascularization[J]. Med Sci Monit, 2018, 24: 4355-4362.
[8]
Hongwei C, Zhang L, Maoping L, et al. Era of liver transplantation: combined anatomic splenectomy and anticoagulant therapy in prevention of portal vein thrombosis after splenectomy[J]. Hepatogastroenterology, 2015, 62(138): 405-409.
[9]
Wu S, Wu Z, Zhang X, et al. The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization[J]. Turk J Gastroenterol, 2015, 26(5): 423-428.
[10]
Rottenstreich A, Kleinstern G, Spectre G, et al. Thromboembolic events following splenectomy: risk factors, prevention, management and outcomes[J]. World J Surg, 2018, 42(3): 675-681.
[11]
Li M, Li J, Meng G, et al. Protective effects of diltiazem against vascular endothelial cell injury induced by angiotensin-II and hypoxia[J]. Clin Exp Pharmacol Physiol, 2015, 42(4): 337-343.
[12]
赵东, 李红春, 陶红光, 等. 门静脉血栓形成的临床诊治分析[J/CD]. 中华肝脏外科手术学电子杂志, 2017, 6(1): 45-48.
[1] 曹琨芃, 王昕玥, 吴柳希, 邓红艳, 李璐, 徐超丽, 叶新华. 淋巴瘤患者超声引导下颈内静脉置管术后静脉血栓形成的危险因素评估[J/OL]. 中华医学超声杂志(电子版), 2024, 21(03): 310-318.
[2] 王啸, 李一凡, 沈素红, 曹国瑞, 史小涛, 袁彦浩, 谭红略. 全膝关节置换术后早期下肢深静脉血栓形成的时空规律[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 414-420.
[3] 姚金含, 王伟娜, 张玉泉. 妊娠相关深静脉血栓形成患者的预后研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 367-373.
[4] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[5] 贺健, 张骊, 王洪海, 蒋文涛. 肝移植术后脾功能亢进转归及治疗研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 310-314.
[6] 王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[7] 蔡艺丹, 方坚, 张志强, 陈莉, 张世安, 夏磊, 阮梅, 李东良. 经颈静脉肝内门体分流术对肝硬化门脉高压患者肠道菌群及肝功能的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 285-293.
[8] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[9] 卓文锋, 曾桂芳, 杨思加, 赵家立, 邹宝嘉, 白子锐, 林恩, 李坚. 腹腔镜巨脾切除术:逐步打破的手术壁垒[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 783-788.
[10] 邓万玉, 陈富, 许磊波. 肝硬化与非肝硬化乙肝相关性肝癌患者术后无复发生存比较及其影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 670-674.
[11] 杨竞, 周光文. 肝硬化门静脉高压症治疗后再出血危险因素分析及预测模型构建[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 296-301.
[12] 崔健, 夏青, 林云, 李光玲, 李心娜, 王位. 血小板与淋巴细胞比值、免疫球蛋白、心肌酶谱及心电图对中老年肝硬化患者病情及预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 400-406.
[13] 秦相清, 朱陈, 张海银. 构建诺模图模型预测肝硬化食管胃底静脉曲张出血的风险[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 330-335.
[14] 刘燚隆, 党荣广, 艾蓉, 张凯. 肝硬化合并静脉曲张出血患者内镜治疗后再出血风险的模型建立与验证[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 336-342.
[15] 戚泽雪, 赵连晖, 王广川, 张春清. 从国内专家共识推荐意见更新探讨经颈静脉肝内门体分流术的临床应用进展[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(03): 193-196.
阅读次数
全文


摘要