摘要
目的探讨腹腔镜脾切除术后门静脉系统血栓(portal vein system thrombosis,PVST)形成的危险因素及防治方法,以及术后使用抗凝剂对PVST的预防作用及效果。方法回顾性观察2009年2月至2016年12月武汉大学中南医院130例行腹腔镜脾切除术病人,根据病人资料自愿选择是否使用抗凝药,分为抗凝组(73例)和非抗凝组(57例)。收集病人的临床资料,观察抗凝组与非抗凝组对术后PVST形成的临床疗效,并对术后PVST形成的围术期相关临床因素进行单因素及多因素Logistic回归分析。同时,分析评价PVST形成的危险因素及其防治方法。结果在PVST组和非PVST组之间血小板平均体积、血小板计数(PLT)、血浆D-二聚体、门静脉直径和脾脏厚度差异均有统计学意义(P<0.05)。与非抗凝组相比,在腹腔镜脾切除术后抗凝组有更低PVST发生率(P=0.044),显著降低的PLT(P=0.001),较低的血小板平均体积(P=0.006),和较低的血浆D-二聚体(P=0.001)。在使用抗凝药物治疗后凝血酶原时间(PT)及国际标准化比值(INR)显著增加。多因素Logistic回归分析结果表明,PLT、血浆D-二聚体、门静脉直径和脾脏厚度是PVST的危险因素,然而抗凝药物使用是PVST的一个独立的保护因素(P=0.001)。结论病人术后D-二聚体、PLT、血小板平均体积显著增加,门静脉直径和脾脏厚度是腹腔镜脾切除术后PVST形成的主要危险因素;应用抗凝治疗可降低术后PVST的发生率。通过分析各危险因素,预测PVST形成,具有重要的临床意义。
Objective To investigate the risk factors and prevention methods of portal vein system thrombosis (PVST) after laparoscopic splenectomy. And postoperative use of anticoagulants on the prevention and effect of PVST. Methods We retrospectively observed 130 patients who underwent laparoscopic splenectomy (LS) in our hospital from February 2009 to December 2016. The patients were randomly divided into anticoagulant group (73 cases) and non-anticoagulant group (57 cases). Clinical data of patients were collected and the clinical effect of anticoagulation group and non-anticoagulation group on postoperative PVST formation were observed, and the perioperative related clinical factors of postoperative PVST formation were analyzed by univariate and multivariate logistic regression analysis. Meanwhile, the risk factors of thrombosis in non-PVST and PVST and their prevention and treatment methods were analyzed and evaluated. Results We analyzed the risk factors of PVST, and results indicated that the mean platelet volume (MPV), platelet count (PLT), plasma d-dimer, thickness of spleen and portal vein diameter were statistically significant ( P <0.05) between PVST group and non-PVST group. Compared with the non-anticoagulant group, anticoagulant group had a lower incidence of PVST ( P =0.044), a significant lower PLT ( P =0.001), a lower mean platelet volume ( P =0.006), and a lower d-dimer ( P =0.001) after LS. And prothrombin time (PT) and international normalized ratio (INR) were significantly increased after treated with anticoagulant drugs. Multiple logistic regression analysis reported that PLT, d-dimer, portal vein diameter and thickness of spleen were the risk factors of PVST, whereas anticoagulant use was an independent protective factor for PVST ( P =0.001). Conclusion D-dimer, platelet count, mean platelet volume, portal vein diameter and spleen thickness are the main risk factors for PVST after laparoscopic splenectomy, and the analysis of each risk factor has certain clinical application value.
作者
王泉雄
方志杰
刘志苏
钱玉元
Wang Quanxiong;Fang Zhijie;Liu Zhisu;Qian Yuyuan(Department of General Surgery, Yunmeng Traditional Chinese Medicine Hospital,Hubei Xiaogan 432500,China;Department of Hepatobiliary and Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Hubei Wuhan 430071,China;Department of Emergency,Zhongnan Hospital of Wuhan University,Hubei Wuhan 430071,China)
出处
《腹部外科》
2019年第4期270-273,279,共5页
Journal of Abdominal Surgery
