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肝硬化门静脉高压患者行脾切除断流术后再出血危险因素分析
Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis
文章发布日期:2015年02月13日  来源:  作者:张 磊,岳 平,宋晓静,等  点击次数:1460次  下载次数:352次

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【摘要】:目的探讨肝硬化门静脉高压症行脾切除贲门周围血管断流术后再出血的危险因素,期望为临床对断流术后降低消化道再出血机率提供一定的依据。方法回顾性分析了兰州大学第一医院2003年12月-2013年12月肝硬化门静脉高压脾切除贲门周围血管断流术患者238例,分为术后再出血组(n=32)及无出血组(n=206),对可能引起术后再出血的诸多因素两组进行对比,用t检验或χ2检验行单因素分析及Logistic多元回归分析,评估脾切除贲门周围血管断流术后再出血的危险因素。结果本组32例患者,食管胃底静脉曲张破裂出血17例,门静脉高压性胃病(PHG)引起出血11例,应激性溃疡出血4例。单因素分析显示,肝功能Child-Pugh分级、术中所见肝硬化程度、胃黏膜病变、PLT、PT、APTT、合并糖尿病在再出血组与无出血组比较差异有统计学意义(P值均<0.05)。经Logistic多元回归分析得出对术后再出血影响显著的独立因素为:合并糖尿病、肝功能Child-Pugh分级、术中见肝硬化程度、弥漫性胃黏膜病变、PT、APTT。结论肝硬化门静脉高压症行脾切除贲门周围血管断流术后针对可能再出血的危险因素采取合适的治疗方法对防止再出血具有重要的临床意义。
【Abstract】:ObjectiveTo investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis, and to provide a certain basis for reducing the incidence of digestive tract re-hemorrhage for these patients. MethodsA retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group (n=32) and non-bleeding group (n=206). Univariate analysis (t test or chi-square test) and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. ResultsOf the 32 patients with postoperative rebleeding, 17 had esophagogastric variceal bleeding, 11 had bleeding due to portal hypertensive gastropathy, and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, pathological changes of the gastric mucosa, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and presence of diabetes (all P<0.05). The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes, Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, diffuse lesion of the gastric mucosa, PT, and APTT. ConclusionFor cirrhotic patients with portal hypertension, the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.
【关键字】:肝硬化;高血压,门静脉;手术后出血;脾切除术;危险因素
【Key words】:liver cirrhosis; hypertension, portal; postoperative hemorrhage; splenectomy; risk factors
【引证本文】:

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