脾切除贲门周围血管离断术后门静脉系统血栓形成患者的肝功能评分
|
摘要
目的探讨脾切除贲门周围血管离断术后患者门静脉系统血栓形成的原因及其对肝功能评分的影响。方法回顾性分析80例脾切除贲门周围血管离断术后肝硬化门静脉高压患者肝功能评分等相关数据,并分析术后患者门静脉系统血栓形成的可能原因。结果术后2组胆碱酯酶水平、总胆红素和Child评分均较术前有明显下降,差异有统计学意义(P<0.05);2组术后白蛋白、凝血酶原时间、胆碱酯酶、总胆红素和Child评分比较,差异均无统计学意义(P>0.05)。血栓组术后出现腹水合并症比例、手术切除脾脏质量、术后红细胞计数、术后D-二聚体水平、术后门静脉内径大于非血栓组,而术后门静脉流速低于非血栓组(P<0.05)。以血栓形成为因变量。以术后出现腹水、手术切除脾脏重量、术后红细胞计数、术后D-二聚体、术后门静脉内径、术后门静脉流速为自变量进行Logistic回归分析,结果显示患者术后D-二聚体升高、术后门静脉内径增加和术后门静脉流速减慢是血栓形成的危险因素。结论脾切除贲门周围血管离断术后患者的肝功能有一定好转,应密切观察患者术后D-二聚体水平,检测其术后门静脉内径和术后门静脉流速,及早预防门静脉系统血栓形成。
Objective To investigate the causes of portal vein thrombosis and the influence of liver function scores in patients with splenectomy and pericardial devascularization. Methods Eighty patients with cirrhotic portal hypertension due to cirrhosis who underwent splenectomy and cardiac vascularization were selected. All patients′ liver function scores and other relevant data before and after surgery were retrospectively analyzed, and the possible causes of portal vein thrombosis were discussed and analyzed. Results After surgery, the levels of cholinesterase, total bilirubin and Child scores were significantly lower than those before surgery, and the difference was statistically significant(P<0.05). After surgery, there were no significant differences in albumin, prothrombin time, cholinesterase, total bilirubin and Child score between two groups(P>0.05). Ascites complication, surgical removal of spleen mass, postoperative red blood cell count, postoperative dimer level, postoperative portal vein diameter were higher or higher than non-thrombotic group, and postoperative portal vein velocity was lower than non-thrombotic group(P<0.05). Logistic regression analysis was performed with thrombosis as the dependent variable, postoperative ascites, surgical removal of spleen mass, postoperative red blood cell count, postoperative dimer, postoperative portal vein diameter, and postoperative portal vein velocity as independent variables. Increased postoperative dimer, increased postoperative portal vein diameter, and slow postoperative portal vein flowere risk factors for thrombosis.Conclusion The liver function of patients with splenectomy and pericardial devascularization is improved. The postoperative dimer level should be closely observed. The postoperative portal vein diameter and postoperative portal vein velocity should be detected to prevent thrombosis in the portal vein.
Objective To investigate the causes of portal vein thrombosis and the influence of liver function scores in patients with splenectomy and pericardial devascularization. Methods Eighty patients with cirrhotic portal hypertension due to cirrhosis who underwent splenectomy and cardiac vascularization were selected. All patients′ liver function scores and other relevant data before and after surgery were retrospectively analyzed, and the possible causes of portal vein thrombosis were discussed and analyzed. Results After surgery, the levels of cholinesterase, total bilirubin and Child scores were significantly lower than those before surgery, and the difference was statistically significant(P<0.05). After surgery, there were no significant differences in albumin, prothrombin time, cholinesterase, total bilirubin and Child score between two groups(P>0.05). Ascites complication, surgical removal of spleen mass, postoperative red blood cell count, postoperative dimer level, postoperative portal vein diameter were higher or higher than non-thrombotic group, and postoperative portal vein velocity was lower than non-thrombotic group(P<0.05). Logistic regression analysis was performed with thrombosis as the dependent variable, postoperative ascites, surgical removal of spleen mass, postoperative red blood cell count, postoperative dimer, postoperative portal vein diameter, and postoperative portal vein velocity as independent variables. Increased postoperative dimer, increased postoperative portal vein diameter, and slow postoperative portal vein flowere risk factors for thrombosis.Conclusion The liver function of patients with splenectomy and pericardial devascularization is improved. The postoperative dimer level should be closely observed. The postoperative portal vein diameter and postoperative portal vein velocity should be detected to prevent thrombosis in the portal vein.
引文
[1] 解长佶,曾志平,胡超,等.肝癌切除联合脾切除、贲门周围血管离断术治疗肝癌合并脾亢的Meta分析[J].中国医学创新,2018,15(33):144-148.
[2] 包汉康,韦秀丽.手助腹腔镜与开腹脾切除贲门周围血管离断术治疗肝硬化门脉高压症的疗效比较[J].临床军医杂志,2016,44(1):92-94,97.
[3] 王卫东,林杰.腹腔镜贲门周围血管离断术联合脾切除治疗门脉高压症在中国的现状[J].世界华人消化杂志,2016,24(23):3461-3467.
[4] 刘新文.腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压30例[J].中国现代普通外科进展,2016,19(4):310-312.
[5] 刘文鹏,王倬,曾强,等.脾切除加贲门周围血管离断术对肝脏血流动力学影响的研究[J].河北医科大学学报,2013,34(2):156-159.
[6] 谢翔,丁佑铭.脾切除贲门周围血管离断术治疗肝硬化门脉高压症的疗效及对患者肝功能指标的影响[J].河北医学,2018,24(3):374-378.
[7] 高树孟.改良腹腔镜下脾切除联合贲门周围血管离断术治疗老年肝硬化性门静脉高压症疗效观察[J].医药论坛杂志,2016,37(11):111-112.
[8] 何盟国,沈乃营,谭栋,等.脾切除贲门周围血管离断术对肝硬化门静脉高压症患者肝脏血流动力学及肝功能的影响[J].中国普外基础与临床杂志,2016,23(8):978-981.
[9] 凌伟明,李鸿飞,黄庆录.脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者肝功能及血流动力学的影响[J/CD].中华普通外科学文献:电子版,2018,12(2):115-119.
[10] 李文省.评价完全腹腔镜脾切除及贲门周围血管离断术治疗门静脉高压症的临床疗效[J/CD].世界最新医学信息文摘:连续型电子期刊,2016,16(39):72,74.
[11] 梅斌.肝硬化门静脉高压症断流术后门静脉血栓形成的防治[J].临床外科杂志,2018,26(5):329-330.
[12] 马宁罗晓,孙宝霞,蒋亚新,等.肝硬化门脉高压症术后门静脉血栓形成的预测[J].中国实验诊断学,2017,21(4):660-662.
[13] 邹盛海,夏木西丁,李忠志.脾切除联合选择性贲门周围血管离断术治疗门静脉高压症效果分析[J].中国普通外科杂志,2017,26(6):801-805.
[14] 石恒彦.腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症效果观察[J].河南医学研究,2017,26(2):313-314.
[15] 李舒凡,张彩云,肖胜兵,等.腹腔镜脾切除联合贲门周围血管离断术对门静脉高压症患者的疗效及预后影响[J].临床医学,2017,37(3):77-79.
[16] 王铁征,武聚山,臧运金,等.脾切除贲门周围血管离断术后肝脏血流动力学及肝脏硬度值的变化[J].北京医学,2016,38(12):1275-1278.
[17] 邓岚岚,张嫄,杨雪松,等.门静脉高压症患者行脾切除及贲门周围血管离断术后肝脏血流动力学变化的超声观测[J].临床超声医学杂志,2016,18(5):304-307.
[18] 胡雄伟,丁同领,洪智贤,等.脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析[J].现代生物医学进展,2018,18(22):4256-4260.
[2] 包汉康,韦秀丽.手助腹腔镜与开腹脾切除贲门周围血管离断术治疗肝硬化门脉高压症的疗效比较[J].临床军医杂志,2016,44(1):92-94,97.
[3] 王卫东,林杰.腹腔镜贲门周围血管离断术联合脾切除治疗门脉高压症在中国的现状[J].世界华人消化杂志,2016,24(23):3461-3467.
[4] 刘新文.腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压30例[J].中国现代普通外科进展,2016,19(4):310-312.
[5] 刘文鹏,王倬,曾强,等.脾切除加贲门周围血管离断术对肝脏血流动力学影响的研究[J].河北医科大学学报,2013,34(2):156-159.
[6] 谢翔,丁佑铭.脾切除贲门周围血管离断术治疗肝硬化门脉高压症的疗效及对患者肝功能指标的影响[J].河北医学,2018,24(3):374-378.
[7] 高树孟.改良腹腔镜下脾切除联合贲门周围血管离断术治疗老年肝硬化性门静脉高压症疗效观察[J].医药论坛杂志,2016,37(11):111-112.
[8] 何盟国,沈乃营,谭栋,等.脾切除贲门周围血管离断术对肝硬化门静脉高压症患者肝脏血流动力学及肝功能的影响[J].中国普外基础与临床杂志,2016,23(8):978-981.
[9] 凌伟明,李鸿飞,黄庆录.脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者肝功能及血流动力学的影响[J/CD].中华普通外科学文献:电子版,2018,12(2):115-119.
[10] 李文省.评价完全腹腔镜脾切除及贲门周围血管离断术治疗门静脉高压症的临床疗效[J/CD].世界最新医学信息文摘:连续型电子期刊,2016,16(39):72,74.
[11] 梅斌.肝硬化门静脉高压症断流术后门静脉血栓形成的防治[J].临床外科杂志,2018,26(5):329-330.
[12] 马宁罗晓,孙宝霞,蒋亚新,等.肝硬化门脉高压症术后门静脉血栓形成的预测[J].中国实验诊断学,2017,21(4):660-662.
[13] 邹盛海,夏木西丁,李忠志.脾切除联合选择性贲门周围血管离断术治疗门静脉高压症效果分析[J].中国普通外科杂志,2017,26(6):801-805.
[14] 石恒彦.腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症效果观察[J].河南医学研究,2017,26(2):313-314.
[15] 李舒凡,张彩云,肖胜兵,等.腹腔镜脾切除联合贲门周围血管离断术对门静脉高压症患者的疗效及预后影响[J].临床医学,2017,37(3):77-79.
[16] 王铁征,武聚山,臧运金,等.脾切除贲门周围血管离断术后肝脏血流动力学及肝脏硬度值的变化[J].北京医学,2016,38(12):1275-1278.
[17] 邓岚岚,张嫄,杨雪松,等.门静脉高压症患者行脾切除及贲门周围血管离断术后肝脏血流动力学变化的超声观测[J].临床超声医学杂志,2016,18(5):304-307.
[18] 胡雄伟,丁同领,洪智贤,等.脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析[J].现代生物医学进展,2018,18(22):4256-4260.