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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 ›› 2017, Vol. 06 ›› Issue (04): 266 -269. doi: 10.3877/cma.j.issn.2095-3232.2017.04.007

所属专题： 文献；

临床研究

贲门周围血管离断术后并发症发生的影响因素分析
刘阳1,†(), 赵耀1, 黎一鸣1, 陈熹1, 刘清峰1   
  1. 1. 71004　西安交通大学医学院第二附属医院普通外科
  • 收稿日期:2017-04-25 出版日期:2017-08-10
  • 通信作者: 刘阳

Influencing factors analysis for the incidence of postoperative complications after pericardical devascularization

Yang Liu1,†(), Yao Zhao1, Yiming Li1, Xi Chen1, Qingfeng Liu1   

  1. 1. Department of General Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an 710061, China
  • Received:2017-04-25 Published:2017-08-10
  • Corresponding author: Yang Liu
  • About author:
    Corresponding author:Liu Yang, Email:
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目的

探讨贲门周围血管离断术后并发症发生的影响因素及其对患者远期生存的影响。

方法

回顾性分析2009年9月至2012年9月在西安交通大学医学院第二附属医院行贲门周围血管离断术的268例门静脉高压症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男160例，女108例；年龄22～77岁，中位年龄47岁；均行脾切除+贲门周围血管离断术。根据患者术后是否发生并发症分为并发症组（57例）和无并发症组（211例）。比较两组围手术期资料，并对患者的生存进行随访。两组临床资料比较采用t检验或Wilcoxon秩和检验，率的比较采用χ2检验。

结果

并发症组既往总出血量>1 000 ml及有内镜下治疗史患者百分率分别为51%（29/57）、26%（15/57），明显高于无并发症组的29%（61/211）、12%（26/211） （χ2=8.749，6.781；P<0.05）。并发症组ALT、AST、PT分别为35（22）U/L、50（31）U/L、（14.1±1.7）s，明显高于无并发症组的26（21）U/L、37（22）U/L、（13.5±1.6）s （Z=2.691，Z=3.063，t=2.479；P<0.05）。随访期间并发症组死亡6例，无并发症组11例，两组患者生存率比较差异无统计学意义（χ2=1.008，P>0.05）。并发症组发生肝细胞癌3例，无并发症组5例，截止投稿日期患者均带瘤生存。

结论

术前大出血、内镜下治疗史、肝功能和凝血功能较差是贲门周围血管离断术后并发症发生的影响因素，但术后并发症的发生并不影响患者远期生存。

关键词: 断流术, 脾切除术, 高血压，门静脉, 手术后并发症, 危险因素
Objective

To investigate the influencing factors for the incidence of postoperative complications after pericardical devascularization and evaluate its effect upon the long-term survival of the patients.

Methods

Clinical data of 268 patients with portal hypertension who underwent pericardical devascularization in the Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine between September 2009 and September 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among the patients, 160 cases were males and 108 were females, aged 22-77 years old with a median age of 47 years old. The patients all underwent splenectomy + pericardical devascularization. According to the postoperative complications happened or not, the patients were divided into the complication group (n=57) and non-complication group (n=211). The perioperative data of two groups were compared and the postoperative survival was followed up. The clinical data of two groups were compared using t test or Wilcoxon rank sum test. The rate was compared using Chi-square test.

Results

The percentage of patients with medical history of total blood loss >1 000 ml and endoscopic treatment in the complication group was respectively 51%(29/57) and 26%(15/57), significantly higher than 29%(61/211) and 12%(26/211) in the non-complication group (χ2=8.749, 6.781; P<0.05). The level of ALT, AST and PT in the complication group was respectively 35(22) U/L, 50(31) U/L and (14.1±1.7) s, significantly higher than 26(21) U/L, 37(22) U/L and (13.5±1.6) s in the non-complication group (Z=2.691, Z=3.063, t=2.479; P<0.05). During postoperative follow-up, 6 patients died in the complication group and 11 in the non-complication group. There was no significant significance in the survival rate between two groups (χ2=1.008, P>0.05). Three cases of hepatocellular carcinoma occurred in the complication group and 5 in the non-complication group, and they all survived until the submission date.

Conclusions

Preoperative massive hemorrhage, medical history of endoscopic treatment, poor liver function and coagulation function are the influencing factors for the incidence of postoperative complications after pericardical devascularization. But these postoperative complications exert no effect upon the long-term survival of the patients.

Key words: Devascularization, Splenectomy, Hypertension, portal, Postoperative complications, Risk factors
表1 并发症组与无并发症组患者围手术期资料比较
临床参数 并发症组 无并发症组 统计值 P值
年龄（岁，±s） 49±11 48±10 0t=0.656 0.513
性别（例） ? ? χ2=2.771 0.096
? 男 40 120 ? ?
? 女 17 091 ? ?
上消化道出血史≥2次（例） 22 052 χ2=3.700 0.054
既往总出血量>1 000 ml（例） 29 061 χ2=8.749 0.003
内镜下治疗史（例） 15 026 χ2=6.781 0.009
肝病病因 ? ? χ2=0.373 0.830
? 乙肝+丙肝 45 174 ? ?
? 乙肝 10 031 ? ?
? 丙肝 02 06 ? ?
肝硬化确诊时间[月，M(QR)] 12（19） 18（18） 00Z=-0.136 0.892
门静脉直径[cm，M(QR)] 1.40（0.10） 1.50（0.10） 00Z=-0.300 0.764
脾静脉直径（cm，±s） 1.20±0.30 1.21±0.30 00t=-0.223 0.823
脾脏最大长径（cm，±s） 21.8±5.70 21.9±7.60 00t=-0.093 0.926
WBC[×1012/L，M(QR)] 1.8（2.4） 2.2（1.3） 00Z=-1.548 0.224
Hb（g/L，±s） 099±200 103±190 00t=-1.343 0.180
Plt[×109/L，M(QR)] 38（28） 40（26） 00Z=-1.383 0.122
ALT[U/L，M(QR)] 35（22） 26（21） 0Z=2.691 0.007
AST[U/L，M(QR)] 50（31） 37（22） 0Z=3.063 0.002
ALB（g/L，±s） 37±30 38±40 00t=-0.649 0.517
TB[μmol/L，M(QR)] 33（17） 24（13） 00Z=1.8540 0.640
PT（s，±s） 14.1±1.70 13.5±1.60 00t=2.4790 0.014
术中出血量[ml，M(QR)] 0800（1 100） 600（550） 00Z=1.1910 0.234
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