脾切除术联合门奇静脉断流术治疗乙型肝炎肝硬化患者门静脉血栓形成影响因素分析*

doi:10.3969/j.issn.1672-5069.2025.06.021

摘要/Abstract

摘要： 目的探讨影响乙型肝炎肝硬化患者脾切除术联合门奇静脉断流术后门静脉血栓形成(PVT)的危险因素,以期为个体化干预提供经验依据。方法 2022年1月～2024年12月我院诊治的乙型肝炎肝硬化患者96例,均接受脾切除术联合门奇静脉断流术治疗。常规获取临床资料,采用多因素Logistic回归分析影响PVT形成的危险因素。结果在96例接受手术的患者中,在术后3周经超声检查发现发生PVT者34例(35.4%);PVT组基线Child-Pugh评分为(10.0±1.4),显著高于无PVT组【(6.9±1.2),P<0.05】,术后应用低分子右旋糖苷或低分子肝素等抗凝干预占比分别为8.8%和14.7%,显著低于无PVT组(分别为27.4%和33.9%,P<0.05); PVT组术前血小板计数为(64.2±16.9)×10⁹/L,显著低于无PVT组【(88.0±14.8)×10⁹/L,P<0.05】,而术后峰值为(180.5±24.1)×10⁹/L,显著高于无PVT组【(126.8±15.0)×10⁹/L,P<0.05】;术前PVT组门静脉内径、脾脏长径和脾脏厚度显著大于无PVT组(P<0.05),而门静脉血流流速显著慢于无PVT组(P<0.05);多因素Logistic回归分析结果显示术前肝功能Child分级和术后PLT计数为影响PVT发生的独立危险因素(P<0.05),而术后及时抗凝干预则是保护性因素(P<0.05)。结论了解影响乙型肝炎肝硬化患者脾切除术联合门奇静脉断流术后PVT形成的危险因素有助于做到胸中有数,及时干预,或可减少该严重并发症的发生,提高手术效果。

关键词: 肝硬化, 脾切除术, 门奇静脉断流术, 门静脉血栓形成, 危险因素

Abstract: Objective The aim of this study was to investigate the risk factors influencing portal vein thrombosis (PVT) after splenectomy and portoazygous devascularization in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 96 patients with hepatitis B-induced LC were encountered in our hospital between January 2022 and December 2024, and all underwent splenectomy and portoazygous devascularization. General clinical materials were obtained routinely, and multivariate Logistic regression analysis was performed to identify risk factors influencing PVT formation. Results Of 96 patients with LC, ultrasonography found PVT in 34 cases (35.4%) three weeks after surgery; Child-Pugh score at baseline in patients with PVT was (10.0±1.4), significantly higher than [(6.9±1.2) in those without (P<0.05), and percentages of prophylactic intravenous administration of low molecular dextran or low molecular heparin for anticoagulant interventions after operation were 8.8% and 14.7%, both much lower than 27.4% and 33.9% (P<0.05) in those without; pre-operational platelet (PLT) count was (64.2±16.9)×10⁹/L, much lower than [(88.0±14.8)×10⁹/L, P<0.05], while it peaked to (180.5±24.1)×10⁹/L post-operationally, much higher than [(126.8±15.0)×10⁹/L, P<0.05] in those without; portal vein diameter, spleen length and spleen thickness at admission were much greater than, while portal blood flow velocity was much slower than in those without (P<0.05); multivariate Logistic regression analysis demonstrated that pre-operational Child-Pugh score and post-operational PLT counts were the independent risk factors for PVT formation after surgery (P<0.05), while post-operational anticoagulant measures exhibited protective roles(P<0.05). Conclusion The risk factors promoting PVT formation after splenectomy and portoazygos devascularization in patients with LC should be taken into consideration, as appropriate prophylactic interventions might prevent it occurrence and promote prognosis.

Key words: Liver cirrhosis, Splenectomy, Portoazygous devascularization, Portal vein thrombosis, Risk factors

陆涛, 李家国, 李士伟, 姚豪杰. 脾切除术联合门奇静脉断流术治疗乙型肝炎肝硬化患者门静脉血栓形成影响因素分析^*[J]. 实用肝脏病杂志, 2025, 28(6): 882-885.

Lu Tao, Li Jiaguo, Li Shiwei, et al. Risk factors influencing portal vein thrombosis after splenectomy and portoazygous devascularization in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(6): 882-885.

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脾切除术联合门奇静脉断流术治疗乙型肝炎肝硬化患者门静脉血栓形成影响因素分析^*

Risk factors influencing portal vein thrombosis after splenectomy and portoazygous devascularization in patients with hepatitis B-induced liver cirrhosis

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