中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

肝硬化门静脉高压症术后腹腔内出血风险因素分析及治疗对策

徐    威，李敬东，田云鸿，李    强，李德新   

  1. 川北医学院附属医院普外科 肝胆胰肠研究所，四川南充637000
  • 发布日期:2012-02-24

  • Published:2012-02-24

摘要：

目的    探讨肝硬化门静脉高压症（PH）术后发生腹腔内出血(PITH)的风险因素和治疗对策。方法  回顾性分析2004年1月至2011年1月川北医学院附属医院手术治疗的259例PH临床资料。二分类Logistic回归行发生PITH的单因素和多因素分析。ROC曲线确定截点值。结果    259例PH术后发生PITH 15例（5.8%），4例行非手术治疗，11例再次手术探查止血。多因素分析显示INR＞1.5、AFP≥6.245μg/L和门静脉内径＞1.3cm是PH手术治疗后发生PITH的风险因素。不同风险等级PH手术治疗后PITH发生率差异有统计学意义（73.3% vs. 1.6%，P=0.000）。结论    PH手术治疗后发生PITH是潜在致命性并发症，风险等级划分有助于预测和治疗。

关键词: 门静脉高压, 术后并发症, 腹腔内出血, 风险因素

Abstract:

Risk factors and management strategy of intraperitoneal hemorrhage following surgical treatment of portal hypertension   XU Wei, LI Jing-dong, TIAN Yun-hong,et al. Department of General Surgery, Institute of  Hepatobiliary-
pancreatic-intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
Corresponding author：LI Jing-dong，E-mail: lijingdong358@126.com
Abstract    Objective    To explore the risk factors of postoperative intraperitoneal hemorrhage (PITH) following surgical treatment of portal hypertension (PH) and study management strategy. Methods    The clinical data of 259 cases of PH treated surgically from January 2004 to January 2011 in the Affiliated Hospital of North Sichuan Medical College were analyzed retrospectively. Clinical factors were explored for their possible association with occurrence of PITH in univariate and multivariate analysis using Logistic regression model. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity and specificity were applied to define cutoff values for continuous variables appropriated. Results    Among 259 cases, PITH occurred in 15 cases (5.8%). Among 15 cases, haemostasis was achieved successfully with conservative treatment in 4 cases, while re-laparotomy was performed in the rest 11 cases to confirm possible bleeding sites. Multivariate analysis revealed that INR＞1.500, AFP≥6.245μg/L and portal vein diameter＞1.3cm were independent risk factors predicting occurrence of PITH. Risk stratification showed statistically significant difference of PITH occurrence (73.3%vs.1.6%, P=0.000). Conclusion    PITH, as a not-so-often complication following PH surgical management, can not be simply attributed to poor liver function and deserves attention because of possible life-threatening outcome, especially under concomitant liver cirrhosis. Patients in higher risk for developing PITH should be monitored carefully or offered prophylactic treatment.

Key words: portal hypertension；postoperative complication, intraperitoneal hemorrhage；risk factor