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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (05) : 284 -287. doi: 10.3877/cma.j.issn.2095-3232.2015.05.007

所属专题： 文献；

临床研究

门静脉高压症脾切除术后门静脉血栓发生影响因素分析
刘波1,†(), 姚志成1, 胡昆鹏1, 林继宗1, 黄河1, 许世磊1, 王庆亮1, 张鹏1, 杨培生1   
  1. 1. 510530　广州，中山大学附属第三医院岭南医院普通外科
  • 收稿日期:2015-05-22 出版日期:2015-10-10
  • 通信作者: 刘波
  • 基金资助:
    广东省科技计划项目(2013B010404014)

Influencing factors of portal vein thrombosis after splenectomy in patients with portal hypertension

Bo Liu1,†(), Zhicheng Yao1, Kunpeng Hu1, Jizong Lin1, He Huang1, Shilei Xu1, Qingliang Wang1, Peng Zhang1, Peisheng Yang1   

  1. 1. Department of General Surgery, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
  • Received:2015-05-22 Published:2015-10-10
  • Corresponding author: Bo Liu
  • About author:
    Corresponding author: Liu Bo, Email:
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引用本文：

刘波, 姚志成, 胡昆鹏, 林继宗, 黄河, 许世磊, 王庆亮, 张鹏, 杨培生. 门静脉高压症脾切除术后门静脉血栓发生影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2015, 04(05): 284-287.

Bo Liu, Zhicheng Yao, Kunpeng Hu, Jizong Lin, He Huang, Shilei Xu, Qingliang Wang, Peng Zhang, Peisheng Yang. Influencing factors of portal vein thrombosis after splenectomy in patients with portal hypertension[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2015, 04(05): 284-287.

目的

探讨门静脉高压症脾切除术后门静脉血栓（PVT）发生的影响因素。

方法

回顾性分析2012年3月至2015年4月在中山大学附属第三医院岭南医院行脾切除术+胃镜下食管曲张静脉套扎术的67例肝硬化门静脉高压症患者临床资料。其中男47例，女20例；平均年龄（47±8）岁；行腹腔镜脾切除术35例、传统开腹脾切除术32例。所有患者均签署知情同意书，符合医学伦理学规定。根据术后有否发生PVT将患者分为PVT组和无PVT组，比较两组PVT发生的影响因素。PVT发生影响因素比较采用t检验或χ2检验。

结果

门静脉高压症脾切除术后发生PVT 11例，发生率为16% （11/67），其中行腹腔镜术6例、开腹5例。PVT发生与术后Plt和血循环中的D-二聚体浓度有关，PVT组血Plt为（739±39）×109/L ，明显高于无PVT组的（318±51）×109/L（t=14.678，P<0.05）；PVT组血D-二聚体浓度为（7.4±1.1）mg/L ，明显高于无PVT组的（4.0±0.9）mg/L（t=5.458，P<0.05）；而与手术方式无关（χ2=0.028，P>0.05）。

结论

门静脉高压症脾切除术后PVT的发生与Plt和D-二聚体浓度升高有关，而与手术方式无关。

关键词: 脾切除术, 静脉血栓形成, 高血压，门静脉, 血小板计数, D-二聚体
Objective

To investigate the influencing factors of portal vein thrombosis (PVT) after splenectomy in patients with portal hypertension.

Methods

Clinical data of 67 patients with liver cirrhosis and portal hypertension undergoing splenectomy + endoscopic variceal ligation in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between March 2012 and April 2015 were retrospectively studied. Among the 67 patients, 47 were males and 20 were females with the average age of (47±8) years old. Thirty-five patients underwent laparoscopic splenectomy and 32 patients underwent open splenectomy. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into the PVT group and the non-PVT group according to whether PVT developed after surgery. The influencing factors of PVT in two groups were compared. The comparison of the influencing factors of PVT was conducted using t test or chi-square test.

Results

Eleven cases developed PVT after splenectomy with the incidence of 16% (11/67) including 6 cases of laparoscopic splenectomy and 5 of open splenectomy. The incidence of PVT was associated with Plt and the concentration of D-dimer in blood circulation. Blood Plt of the PVT group was (739±39) ×109/L, which was significantly higher than (318±51)×109/L of the non-PVT group (t=14.678, P<0.05). The concentration of D-dimer of the PVT group was (7.4±1.1) mg/L, which was significantly higher than (4.0±0.9) mg/L of the non-PVT group (t=5.458, P<0.05). The incidence of PVT was not associated with surgical procedure (χ2=0.028, P>0.05).

Conclusion

The incidence of PVT after splenectomy is associated with Plt and the concentration of D-dimer and is not associated with surgical procedure.

Key words: Splenectomy, Venous thrombosis, Hypertension, portal, Platelet count, D-dimer
表1 术后PVT和无PVT患者一般资料及实验室指标比较
组别 性别（例） 年龄（岁，±s） 手术方式（例） 手术时间（min，±s） 住院时间（d，±s） 红细胞血液（U，±s） 新鲜冰冻血浆（ml，±s）
男 女 腹腔镜 开腹
PVT组 7 4 49±10 6 5 185±32 7.4±1.1 2.2±0.6 388±80
无PVT组 40 16 47±9 29 27 165±41 6.4±0.9 2.4±0.4 416±61
统计值 χ2=0.267 t=0.336 χ2=0.028 t=0.858 t=1.543 t=-0.620 t=-0.625
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
组别 冷沉淀（U，±s） Plt（109/L，±s） PT（s，±s） INR（±s） 血D-二聚体（mg/L，±s） 血纤维蛋白原（g/L，±s） 脾长径（cm，±s） 门静脉直径（cm，±s）
PVT组 14±5 739±39 14.1±1.4 1.2±0.3 7.4±1.1 2.38±0.31 18±4 1.3±0.4
无PVT组 13±5 318±51 15.2±1.7 1.3±0.2 4.0±0.9 2.51±0.24 19±4 1.1±0.6
统计值 t=0.330 t=14.678 t=-1.128 t=-0.707 t=5.458 t=-0.741 t=-415.000 t=0.642
P值 >0.05 <0.05 >0.05 >0.05 <0.05 >0.05 >0.05 >0.05
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