肝硬化门静脉高压脾功能亢进患者腹腔镜脾切除术后门静脉系统血栓形成的危险因素

摘要/Abstract

摘要： 目的分析肝硬化门静脉高压(CPH)脾功能亢进(HS)行腹腔镜脾切除术(LS)术后门静脉系统血栓形成(PVST)的高危因素。方法选取2019年1月至2023年12月海安市人民医院收治的CPH合并HS患者69例,根据术后1周是否发生LS-PVST,分为LS-PVST组(n=18)和非LS-PVST组(n=51)。收集研究对象的基线资料、血清学和影像学指标。logistic回归分析CPH合并HS患者发生LS-PVST的影响因素,绘制受试者工作曲线(ROC)分析各独立影响因素的预测价值。结果 69例患者中,术后1周发生LS-PVST 18例(26.09%)。LS-PVST组的糖尿病史、上消化道出血病史、术前纤维蛋白原(FBI)、术前门静脉内径(PVD)、术前脾脏长径(SL)、术中出血量、术中输血量、术后第3天血小板升高率(PPER3)、D-二聚体(D-D)水平分别为44.44%、22.22%、3.49 g/L、(18.24±1.86)mm、(19.06±1.95)mm、(376.49±45.37)mL、(254.56±28.41)mL、1.47%、2.03 mg/L,均高于非LS-PVST组的19.61%、7.84%、3.14 g/L、(15.47±1.69)mm、(15.83±1.82)mm、(321.76±41.05)mL、(216.90±24.52)mL、1.18%、0.84 mg/L,差异有统计学意义(t/χ²=4.836,4.259,4.576,7.465,7.263,5.034,5.628,8.476,9.158,均P<0.05)。logistics回归分析显示,术前PVD、术前SL和术后PPER3、D-D水平升高为CPH合并HS患者发生LS-PVST的独立影响因素(95%CI为0.754～1.705、0.713～1.627、0.860～1.842、0.917～1.863,OR=1.162、1.048、1.256、1.379,均P<0.05)。ROC分析显示,术前PVD、术前SL和术后PPER3、术后D-D水平的曲线下面积(AUC)分别为0.773、0.695、0.845和0.758,敏感度为72.22%、77.78%、88.89%、83.33%,特异度为83.33%、66.67%、72.22%、66.67%。结论术前PVD、术前SL和术后PPER3、术后D-D水平升高是CPH合并HS患者发生LS-PVST的独立影响因素,可作为LS围手术期预防、评估和干预PVST的参考依据。

关键词: 肝硬化门静脉高压, 腹腔镜脾切除术, 门静脉系统血栓形成, 危险因素, 围术期管理

Abstract: Objective To analyze the risk factors of portal vein thrombosis (PVT) after laparoscopic splenectomy (LS) for hepatic portal hypertension (CPH) and hypersplenism (HS), and to provide reference for the prevention and treatment of perioperative PVT. Methods A total of 69 CPH patients with HS treated with LS were selected from People's Hospital of Hai’an from January 2020 to December 2023. According to whether LS-PVT occurred in imaging examination in one week after surgery, they were divided into LS-PVT group (n=18) and non-LS-PVT group (n=51). Baseline data, serological and imaging indicators were collected. Univariate and Logistic multivariate analysis were conducted to analyze the risk factors and independent influencing factors of LS-PVT in CPH patients combined with HS, and the predictive value of each independent influencing factor was analyzed by receiver operating curve (ROC) method. Results Among 69 patients with CPH combined with HS, 18 cases of LS-PVT occurred within 1 week after surgery, with an incidence rate of 26.09%. History of diabetes mellitus, history of upper gastrointestinal bleeding, preoperative fibrinogen (FBI), preoperative portal vein diameter (PVD), preoperative spleen length diameter (SL), intraoperative blood loss, intraoperative blood transfusion volume, platelet elevation rate (PPER3) in 3 days post-operation, and D-dimer (D-D) level in LS-PVT group were 44.44%, 22.22%, 3. 49 g/L, 18.24±1.86 mm, 19.06±1.95 mm, 376.49±45.37 mL, 254.56±28.41 mL, 1.47%, 2.03 mg/L, respectively. All of them were higher than those of 19.61%, 7.84%, 3.14 g/L, 15.47±1.69 mm, 15.83±1.82 mm, 321.76±41.05 mL, 216.90±24.52 mL, 1.18%, 0.84 mg/L in the non-LS-PVT group. The differences were statistically significant (t/χ²=4.836, 4.259, 4.576, 7.465, 7.263, 5.034, 5.628, 8.476, 9.158, all P<0.05). Logistics regression analysis shows that Increased levels of PVD and SL before surgery and PPER3 and D-D after surgery were independent influencing factors for the occurrence of LS-PVT in CPH patients with HS (95%CI: 0.754 ~ 1.705, 0.713 ~ 1.627, 0.860 ~ 1.842, 0.917 ~ 1.863; OR=1.162, 1.048, 1.256, 1.379, all P<0.05). ROC analysis showed that the areas under the curve (AUC) of preoperative PVD, SL and postoperative PPER3 and D-D levels were 0.773, 0.695, 0.845 and 0.758, respectively, with sensitivities of 72.22%, 77.78%, 88.89% and 83.33%. The specificities were 83.33%, 66.67%, 72.22%, and 66.67% (all P<0.01). Conclusion The increased levels of PVD and SL before surgery and PPER3 and D-D after surgery are independent influencing factors for the occurrence of LS-PVT in CPH patients with HS, and can be used as a reference for the prevention, evaluation and intervention of PVT in the perioperative period of LS.

Key words: Hepatic portal hypertension, Hypersplenism, Portal vein thrombosis, Risk factors, Perioperative management

刘佳, 刘艳, 陈晋. 肝硬化门静脉高压脾功能亢进患者腹腔镜脾切除术后门静脉系统血栓形成的危险因素[J]. 肝脏, 2025, 30(5): 604-608.

LIU Jia, LIU Yan, CHEN Jin. An analysis on the risk factors of portal vein thrombosis in cirrhotic patients with portal hypertension and hypersplenism after laparoscopic splenectomy[J]. Chinese Hepatolgy, 2025, 30(5): 604-608.

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