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断流术治疗门静脉高压症的预后影响因素分析

Analysis of prognostic factors of portal hypertension treated with devascularization

摘要:

目的 探讨断流术治疗门静脉高压症的预后因素.方法 回顾性分析1993年2月至2014年4月在南京大学医学院附属鼓楼医院接受断流术的397例门静脉高压症患者资料,其中男性242例,女性155例,年龄12 ~79岁,中位年龄48岁.采用Logistic回归分析筛选围手术期并发症的预后因素.通过门诊复查、电话随访、信函回访等方式对患者进行随访,采用Kaplan-Meier法绘制生存曲线,进行单因素Log-rank检验及多因素Cox回归分析得出影响患者长期生存的预后因素.结果 397例患者均完成手术治疗,术后死亡8例,顺利出院389例.Logistic回归分析结果表明,年龄(≥48岁)(X2=4.559,OR=2.048,P=0.033)、术前内镜下红色征(X2=4.959,OR =2.129,P=0.026)及未保留门奇侧支静脉(X2=13.348,OR=5.122,P=0.000)是发生围手术期并发症的预后因素.截止至2015年10月,共有370例患者获得随访,失访率为6.8%.随访时间0~21.5年,平均随访时间(5.7±4.6)年,随访期内与研究疾病相关的死亡103例.术后1、3、5、10、15、20年的累积生存率分别为93.6%、86.9%、80.1%、59.3%、54.1%、38.5%.单因素分析结果表明,性别(男性)、年龄(≥48岁)、术前上消化道大出血(单次≥500 ml)、病毒性肝炎、未保留门奇侧支静脉是可能影响患者远期生存的预后因素(p<0.05).多因素分析结果表明,年龄(≥48岁)(X2=9.850,RR=1.904,P=0.002)、术前上消化道大出血(单次≥500 ml)(X2=34.402,RR=3.273,P=0.000)、病毒性肝炎(X2=7.573,RR=2.525,P=0.006)、未保留门奇侧支静脉(X2=5.905,RR=1.889,P =0.015)是影响远期预后的独立预后因素.结论 保留门奇侧支静脉的断流术治疗门静脉高压症可以获得良好的治疗效果及提高远期生存率.

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abstracts:

Objective To explore the prognostic factors of portal hypertension treated with devascularization.Methods A total of 397 patients with portal hypertension underwent devascularization in Nanjing Drum Tower Hospital from February 1993 to April 2014,among which there were 242 male and155 female patients with median age of 48 years.The perioperative data were retrospectively collected.Logistic regression was used to find the risk factors which affect the operative complications.Follow-up evaluation was in progress regularly.Kaplan-Meier survival curve,Log-rank test and Cox regression model were used to find out factors which affect the long-term results.Results All together 397 patients underwent devascularization,in whom 8 patients died perioperative,389 patients discharged successfully.Logistic regression showed that age (≥ 48 years) (X2 =4.559,OR =2.048,P =0.033),red color sign before surgery (x2 =4.959,OR =2.129,P =0.026) and without portosystemic collateral vessels reserved (x2 =13.348,OR =5.122,P =0.000) were risk factors of perioperative complications.The follow-up time was (5.7±4.6) years.Totally 27 patients were lost from follow-up,103 patients died for the disease during follow-up.The survival rate at 1-,3-,5-,10-,15-and 20-years was 93.6%,86.9%,80.1%,59.3%,54.1% and 38.5% respectively.Univariate analysis showed that gender (male),age (≥ 48 years),hemorrhage before surgery (≥500 ml per time),hepatitis virus and without portosystemic collateral vessels reserved were risk factors of the long-term survival (P < 0.05).Cox regression analysis showed that age (≥48 years) (X2 =9.850,RR =1.904,P =0.002),hemorrhage before surgery (≥ 500 ml per time)(X2 =34.402,RR =3.273,P =0.000),hepatitis virus (X2 =7.573,RR =2.525,P =0.006) and without portosystemic collateral vessels reserved (x2 =5.905,RR =1.889,P =0.015) were independent risk factors that affect the long-term survival.Conclusion Devascularization with portosystemic collateral vessels reserved has favorable perioperative and long-term outcome,and it definitely is a very safe and effective technique for portal hypertension.

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