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重型β地中海贫血患者脾切除术后门静脉血栓形成的危险因素:腹腔镜手术与开放手术对比

Risk factors of portal vein thrombosis in patients with beta thalassemia major after splenectomy: laparoscopic versus open procedure.

作者信息

Wang Mingjun, Zhang Mengni, Li Junli, Zhou Jin, Wu Zhong, Peng Bing

出版信息

Hepatogastroenterology. 2014 Jan-Feb;61(129):48-54.

Abstract

BACKGROUND/AIMS: Beta thalassemia major patients are at a high risk of thromboembolic events due to a hypercoagulable state, and nowadays laparoscopic splenectomy (LS) has become the standard surgical procedure for many benign diseases. The aim of this study is to show our experience of LS for beta thalassemia major, and to explore predictive factors for portal vein thrombosis (PVT) after splenectomy.

METHODOLOGY

We performed a retrospective chart review of 25 cases of LS (Group 1) and 34 cases of open splenectomy (OS, Group 2) in beta thalassemia major patients. Patients' perioperative, intraoperative and postoperative information was recorded and compared.

RESULTS

Compared with Group 2, patients in Group 1 had significantly increasing operative time, less estimated blood loss (EBL), decreasing postoperative stays, and shorter duration of oral intake. Related variables were assessed by univariate and multivariate logistic regression analyses, indicating splenic weight (cutoff value: 1311.5 g) was a significant independent predictor for PVT after LS. Regardless of LS or OS, some patients responded to splenectomy completely, while some responded partially.

CONCLUSIONS

According to this study, LS is associated with better surgical outcomes for beta thalassemia major compared with OS. Patients receiving LS may be susceptible to PVT, and splenic weight can be used as a predictor.

摘要

背景/目的:重型β地中海贫血患者因处于高凝状态而具有较高的血栓栓塞事件风险,如今腹腔镜脾切除术(LS)已成为许多良性疾病的标准外科手术。本研究的目的是展示我们对重型β地中海贫血患者行LS的经验,并探讨脾切除术后门静脉血栓形成(PVT)的预测因素。

方法

我们对25例行LS的重型β地中海贫血患者(第1组)和34例行开放性脾切除术(OS,第2组)的患者进行了回顾性病历审查。记录并比较患者的围手术期、术中及术后信息。

结果

与第2组相比,第1组患者的手术时间显著延长,估计失血量(EBL)减少,术后住院时间缩短,口服摄入持续时间缩短。通过单因素和多因素逻辑回归分析评估相关变量,表明脾脏重量(临界值:1311.5 g)是LS后PVT的显著独立预测因素。无论LS还是OS,一些患者对脾切除术完全有反应,而一些患者部分有反应。

结论

根据本研究,与OS相比,LS对重型β地中海贫血患者的手术效果更好。接受LS的患者可能易发生PVT,脾脏重量可作为预测指标。

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