Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis
Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis
复制标题
肝硬化患者脾切除术后门静脉血栓形成的危险因素及临床特征
DOI：
10.1016/s1499-3872(13)60081-8
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发表时间：
2013-10-15
影响因子：
3.3
通讯作者：
Lv, Yi
中科院分区：
文献类型：
--
作者：
Li, Mu-Xing;Zhang, Xu-Feng;Lv, Yi
背景：门静脉血栓（PVT）是一种潜在的致命并发症，可能对肝硬化患者脾切除术后的预后产生负面影响。预防和及时发现PVT具有重要意义。目前对PVT的临床特征和危险因素缺乏了解。本研究旨在探讨PVT的危险因素和临床特征，以找出高危人群。方法：收集2008年1月至2010年12月在我院连续收治的472例接受脾切除术的非肿瘤性肝硬化患者的临床资料。比较术后发生PVT 和未发生PVT 患者的临床和手术特征。对 PVT 危险因素进行单变量和多变量分析。还评估了患者的死亡率和再出血率。结果：472 例患者中，52 例被排除在研究之外。 71 名患者（71/420，16.9%）出现 PVT。多变量分析显示，术前门静脉直径扩大、术后血小板增多、凝血酶原时间延长和食管胃周围血管断流与PVT发生显着相关[比值比(OR)分别为5.701、2.807、1.850和2.090]。服用抗血小板药物的患者PVT发生率并不低于未服用抗血小板药物的患者。随访显示PVT组患者有总生存率降低的趋势，但无统计学意义。 PVT组消化道出血发生率高于非PVT组（P=0.044）。结论：术前门静脉内径增宽、术后血小板增多、凝血酶原时间延长、食管胃周围血管断流是PVT发生的独立危险因素。 PVT与术后胃肠道出血的较高风险相关，但对总生存期没有显着影响。
BACKGROUND: Portal vein thrombosis (PVT) is a potential lethal complication and may have negative influence on the prognosis after splenectomy in patients with liver cirrhosis. Prevention and timely detection of PVT are quite significant. There is a lack of knowledge about the clinical features and risk factors of PVT. Our study aimed to investigate the risk factors and clinical characteristics of PVT in order to figure out the high-risk individuals.METHODS: We collected the clinical data of 472 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2008 to December 2010 in our institution. Clinical and surgical characteristics of patients who developed PVT postoperatively and those who did not develop PVT were compared. Univariate and multivariate analyses of risk factors of PVT were performed. The mortality and rebleeding rate of the patients were also evaluated.RESULTS: Of the 472 patients, 52 were excluded from the study. PVT developed in 71 (71/420, 16.9%) patients. Multivariate analysis revealed that wider preoperative portal vein diameter, postoperative thrombocytosis, prolonged prothrombin time and periesophagogastric devascularization were significantly correlated with PVT development [odds ratio (OR): 5.701, 2.807, 1.850 and 2.090, respectively]. The incidence of PVT in patients who took antiplatelet drugs was not lower than that in those who did not. Follow-up showed that patients in the PVT group had a tendency towards reduced overall survival but it was not statistically significant. Gastrointestinal bleeding occurred more often in the PVT group than that in the non-PVT group (P=0.044).CONCLUSIONS: Wider preoperative portal vein diameter, postoperative thrombocytosis, prolonged prothrombin time and periesophagogastric devascularization are independent risk factors of PVT. PVT is related with higher risk of postoperative gastrointestinal hemorrhage but has no significant impact on the overall survival.