Risk factors for pleural effusion after pericardial devascularization: clinical analysis of 12 cases

doi:10.3877/cma.j.issn.1674-0793.2014.04.010

Abstract

Abstract:

Objective

To investigate the risk factors for pleural effusion and the corresponding prophylactico-therapeutic measures after pericardial devascularization in patients with portal hypertension.

Methods

Seventy-seven cases with portal hypertension after hepatitis undergoing pericardial devascularization in the Third Department of General Surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from Mar 2008 to Sep 2012 were selected for a retrospective study.

Results

In these 77 patients, 7 cases(9.1%) accepted nonselective splenic embolism before operation. The types of operation were divided into two groups, 70 cases(90.9%) accepted splenectomy plus pericardial devascularization without esophageal transection, the other 7 cases(9.1%) were given modified Sugiura operation. All patients recovered after operation with an average hospitalization time of (16.7±2.2) days. There was no death or second operation in these 77 cases. Pleural effusion emerged in 12 cases(15.6%) after the operation. By using single factor analysis, the pleural effusion after pericardial devascularization was related to the types of operation, hepatic Child-Pugh classification and nonselective splenic embolism before operation, and to the size of spleen, spleen adhesions around. The difference was statistically significant (P<0.05). By using multiple factors logistic regression analysis, the type of operation and the nonselective splenic embolism before operation were the independent factors of pleural effusion (P<0.05).

Conculsion

Through avoiding nonselective splenic embolism before operation, selecting appropriate operation type and improving operational skills, we can reduce the occurrence of pleural effusion after pericardial devascularization.

Key words: Pericardial devascularization, Sugiura, Pleural effusion

Genglong Zhu, Dong Chen, Yonghui Su, Yingbin Jia, Nanrenqing Suo, Xiaodong Guan, Xiaopeng Hong, Baimeng Zhang. Risk factors for pleural effusion after pericardial devascularization: clinical analysis of 12 cases[J]. Chinese Archives of General Surgery(Electronic Edition), 2014, 08(04): 294-297.

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Figures/Tables 2

References 10

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影响因素		例数	并发胸腔积液	无胸腔积液	χ²值	P值
性别		?	?	?	?	?
?	男	60	9	51	0.071	1.000
?	女	17	3	14	0.071	1.000
年龄（岁）		?	?	?	?	?
?	<50	40	5	35	0.602	0.438
?	≥50	37	7	30	0.602	0.438
Child-Pugh分级		?	?	?	?	?
?	A	60	6	54	6.442	0.020^a
?	B	17	6	11	6.442	0.020^a
手术时间（min）		?	?	?	?	?
?	≤180	27	2	25	2.113	0.197
?	>180	50	10	40	2.113	0.197
手术失血量（ml）		?	?	?	?	?
?	<500	35	5	30	0.082	0.774
?	≥500	42	7	35	0.082	0.774
脾肿大程度		?	?	?	?	?
?	轻	18	7	11	?	?
?	中	52	4	48	9.902	0.015^b
?	重	7	1	6	?	?
术前吸烟		?	?	?	?	?
?	无	39	3	36	3.741	0.053
?	有	38	9	29	3.741	0.053
术前血小板数（×10⁹/L）		?	?	?	?	?
?	<50	9	2	7	0.341	0.625
?	≥50	68	10	58	0.341	0.625
离断食管		?	?	?	?	?
?	无	70	7	63	18.253	0.001^c
?	有	7	5	2	18.253	0.001^c
脾周粘连		?	?	?	?	?
?	无	68	7	61	12.377	0.004^d
?	有	9	5	4	12.377	0.004^d
术前行脾动脉栓塞		?	?	?	?	?
?	无	70	8	62	10.109	0.010^e
?	有	7	4	3	10.109	0.010^e
急诊手术		?	?	?	?	?
?	否	65	10	55	0.013	1.000
?	是	12	2	10	0.013	1.000

影响因素		例数	并发胸腔积液	无胸腔积液	χ²值	P值
性别		?	?	?	?	?
?	男	60	9	51	0.071	1.000
?	女	17	3	14	0.071	1.000
年龄（岁）		?	?	?	?	?
?	<50	40	5	35	0.602	0.438
?	≥50	37	7	30	0.602	0.438
Child-Pugh分级		?	?	?	?	?
?	A	60	6	54	6.442	0.020^a
?	B	17	6	11	6.442	0.020^a
手术时间（min）		?	?	?	?	?
?	≤180	27	2	25	2.113	0.197
?	>180	50	10	40	2.113	0.197
手术失血量（ml）		?	?	?	?	?
?	<500	35	5	30	0.082	0.774
?	≥500	42	7	35	0.082	0.774
脾肿大程度		?	?	?	?	?
?	轻	18	7	11	?	?
?	中	52	4	48	9.902	0.015^b
?	重	7	1	6	?	?
术前吸烟		?	?	?	?	?
?	无	39	3	36	3.741	0.053
?	有	38	9	29	3.741	0.053
术前血小板数（×10⁹/L）		?	?	?	?	?
?	<50	9	2	7	0.341	0.625
?	≥50	68	10	58	0.341	0.625
离断食管		?	?	?	?	?
?	无	70	7	63	18.253	0.001^c
?	有	7	5	2	18.253	0.001^c
脾周粘连		?	?	?	?	?
?	无	68	7	61	12.377	0.004^d
?	有	9	5	4	12.377	0.004^d
术前行脾动脉栓塞		?	?	?	?	?
?	无	70	8	62	10.109	0.010^e
?	有	7	4	3	10.109	0.010^e
急诊手术		?	?	?	?	?
?	否	65	10	55	0.013	1.000
?	是	12	2	10	0.013	1.000

因素	B	标准误（SE）	Wald	P值	相对危险度（OR）	95%可信区间（95% CI）
性别	-2.406	2.275	1.119	0.290	0.090	0.001~7.787
年龄	-0.096	1.574	0.004	0.951	0.908	0.042~19.866
Child-Pugh分级	-0.135	1.567	0.007	0.931	0.874	0.040~18.860
手术时间	2.666	2.450	1.184	0.276	14.381	0.118~1749.727
手术失血量	-0.981	1.309	0.562	0.454	0.375	0.029~4.880
脾肿大程度1	?	?	0.215	0.898	?	?
脾肿大程度2	1.365	3.590	0.144	0.704	3.914	0.003~4454.051
脾肿大程度3	0.818	3.575	0.052	0.819	2.265	0.002~2498.718
术前吸烟	0.913	1.614	0.320	0.571	2.492	0.105~58.898
术前血小板数值	2.330	2.127	1.201	0.273	10.279	0.159~663.961
手术方式	4.527	2.040	4.925	0.026^a	92.453	1.697~5037.641
脾周粘连	3.512	2.509	1.959	0.162	33.514	0.245~4583.141
术前脾动脉栓塞	5.337	2.540	4.413	0.036^b	207.833	1.430~30201.980
急诊手术	-1.132	2.384	0.225	0.635	0.323	0.003~34.519

因素	B	标准误（SE）	Wald	P值	相对危险度（OR）	95%可信区间（95% CI）
性别	-2.406	2.275	1.119	0.290	0.090	0.001~7.787
年龄	-0.096	1.574	0.004	0.951	0.908	0.042~19.866
Child-Pugh分级	-0.135	1.567	0.007	0.931	0.874	0.040~18.860
手术时间	2.666	2.450	1.184	0.276	14.381	0.118~1749.727
手术失血量	-0.981	1.309	0.562	0.454	0.375	0.029~4.880
脾肿大程度1	?	?	0.215	0.898	?	?
脾肿大程度2	1.365	3.590	0.144	0.704	3.914	0.003~4454.051
脾肿大程度3	0.818	3.575	0.052	0.819	2.265	0.002~2498.718
术前吸烟	0.913	1.614	0.320	0.571	2.492	0.105~58.898
术前血小板数值	2.330	2.127	1.201	0.273	10.279	0.159~663.961
手术方式	4.527	2.040	4.925	0.026^a	92.453	1.697~5037.641
脾周粘连	3.512	2.509	1.959	0.162	33.514	0.245~4583.141
术前脾动脉栓塞	5.337	2.540	4.413	0.036^b	207.833	1.430~30201.980
急诊手术	-1.132	2.384	0.225	0.635	0.323	0.003~34.519

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