肝硬化患者部分脾栓塞术后并发症的危险因素
Risk factors for complications after partial splenic embolization for liver cirrhosis.
作者信息
Hayashi H, Beppu T, Okabe K, Masuda T, Okabe H, Baba H
机构信息
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
Br J Surg. 2008 Jun;95(6):744-50. doi: 10.1002/bjs.6081.
BACKGROUND
Partial splenic embolization (PSE) in patients with cirrhosis can achieve a prolonged increase in blood cell count. However, there is little information on the risk factors for complications after PSE for liver cirrhosis.
METHODS
Seventy patients (41 men and 29 women) with cirrhosis-induced hypersplenism underwent PSE. Based on the Child-Pugh classification, 30, 35 and five patients had class A, B and C disease respectively. Risk factors for complications after PSE were examined retrospectively by logistic regression analysis.
RESULTS
The mean splenic infarction rate was 77.1 per cent. Twelve patients (17 per cent) had complications following PSE. In univariable analysis, Child-Pugh class C, total bilirubin level of 1.4 mg/dl or more, serum albumin level of 2.8 g/dl or less and infarcted splenic volume of 540 ml or more were significantly associated with complications after PSE. In multivariable analysis, Child-Pugh class C (P = 0.012) and infarcted splenic volume of 540 ml or more (P = 0.031) were identified as risk factors, with an odds ratio of 22.92 and 5.01 respectively.
CONCLUSION
Child-Pugh class C and a large splenic infarction volume are risk factors for complications after PSE for liver cirrhosis.
背景
肝硬化患者行部分脾栓塞术（PSE）可使血细胞计数长期升高。然而，关于肝硬化患者PSE术后并发症的危险因素的信息较少。
方法
70例肝硬化所致脾功能亢进患者接受了PSE。根据Child-Pugh分级，分别有30、35和5例患者为A、B、C级疾病。通过逻辑回归分析对PSE术后并发症的危险因素进行回顾性研究。
结果
平均脾梗死率为77.1%。12例患者（17%）PSE术后出现并发症。单因素分析显示，Child-Pugh C级、总胆红素水平≥1.4mg/dl、血清白蛋白水平≤2.8g/dl以及梗死脾体积≥540ml与PSE术后并发症显著相关。多因素分析确定，Child-Pugh C级（P = 0.012）和梗死脾体积≥540ml（P = 0.031）为危险因素，比值比分别为22.92和5.01。
结论
Child-Pugh C级和较大的脾梗死体积是肝硬化患者PSE术后并发症的危险因素。
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