摘要目的 分析肝硬化门静脉高压症行脾切断流术后门静脉血栓的术前相关危险因素.方法 回顾性分析2010年1月至2012年12月因肝硬化门静脉高压症行脾切断流手术的127例患者的临床资料,分为血栓组和非血栓组,对可能导致门静脉血栓形成的术前相关因素进行多因素分析.计量资料采用Student t检验分析,计数资料采用x2检验分析.结果 患者性别、年龄、急诊手术、出血入院、腹水、食管胃底静脉曲张程度、Child-Pugh分级、术前脾静脉直径、术前肝功能(ALT、总胆红素、直接胆红素、白蛋白、球蛋白、胆碱酯酶、γ-谷氨酰转移酶)、术前肾功能(肌酐)、术前凝血功能指标(凝血酶原时间、凝血酶原活动度、活化部分凝血酶原时间、国际标准化比值、纤维蛋白原、凝血酶时间、抗凝血酶Ⅲ)等在两组间的差异无统计学意义;出血病史、术前门静脉直径、AST、尿素氮在两组间的差异有统计学意义(P＜ 0.05).术前门静脉直径和出血病史是门静脉血栓形成的独立危险因素[门静脉直经:比值比为1.681,95.0％可信区间(CI)为1.300 ～ 2.173,P＜ 0.01;出血病史:比值比为2.446,95.0％ CI为1.019 ～ 5.870,P＜0.05].有出血病史患者术前门静脉直径＞13.15 mm(受试者工作特征曲线下面积为0.813,95.0％CI为0.701 ～ 0.926),及无出血病史患者术前门静脉直径＞13.57 mm时(受试者工作特征曲线下面积为0.726,95.0％ CI为0.600 ～ 0.853),术后容易形成门静脉血栓.结论 肝炎肝硬化门静脉高压症行脾切断流手术的患者,术前门静脉直径及出血病史是术后门静脉血栓发生的独立危险因素.

abstractsObjective To investigate the preoperative risk factors of portal venous thrombosis (PVT) after splenectomy and gastric pericardial devascularization in patients with liver cirrhosis and portal hypertension.Methods Clinical data was collected for 127 patients who underwent splenectomy and gastric pericardial devascularization for portal hypertension at our hospital between January 2010 and December 2012.The patient data were analyzed retrospectively according to patient status of presence or absence of PVT postoperatively.The preoperative risk factors of PVT were statistically analyzed.Results There were no significant differences between the postoperative PVT-positive and-negative groups in regards to sex,age,receipt of emergency surgery,presence of ascites,admission to hospital for upper gastrointestinal bleeding,grade of esophageal-gastric varices,Child-Pugh classification,spleen vein diameter,liver function (as determined by levels of alanine aminotransferase,total bilirubin,direct bilirubin,albumin,globulin,cholinesterase,and gamma-glutamyltransferase),renal function (as determined by creatinine level),and coagulation function (as determined by prothrombin time,prothrombin activity degree,activated partial thromboplastin time,international normalized ratio,fibrinogen,thrombin time,and antithrombin Ⅲ).However,there were significant differences between the groups for the parameters of postoperative PVT presence,upper gastric bleeding history,aspartate aminotransferase level,and blood urea nitrogen level (all P ＜ 0.05).Portal vein diameter and history of upper gastric bleeding were both identified as independent risk factors for PVT (P ＜ 0.05).Incidence of postoperative PVT was higher in patients who had portal vein diameter ＞13.15 mm (cutoff value of 13.75 mm) and in patients who had a history of upper gastric bleeding.Conclusion Portal vein diameter and history of upper gastric bleeding were independent risk factors for PVT occurrence after splenectomy and gastric pericardial devascularization in patients with liver cirrhosis and portal hypertension.