Bai Dou-Sheng, Shao Wen-Yu, Zhang Chi, Chen Ping, Jin Sheng-Jie, Jiang Guo-Qing
Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China.
Key Laboratory of Living Donor Liver Transplantation, Department of Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Turk J Gastroenterol. 2019 Mar;30(3):254-259. doi: 10.5152/tjg.2018.18207.
BACKGROUND/AIMS: Splenectomy is regarded as an effective curative treatment for thrombocytopenia caused by hypersplenism in patients with cirrhosis. However, in clinical practice, thrombocytopenia is not resolved by splenectomy in all patients. This study aimed to evaluate the adverse factors responsible for platelet (PLT) counts below the normal lower limit following laparoscopic splenectomy and azygoportal disconnection (LSD).
We retrospectively evaluated the outcomes of 123 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism, who underwent LSD and who had PLT counts <125×109/L (non-normal group) or >125×109/L (normal group) at the postoperative month (POM) 3, between April 2014 and March 2017.
Sixteen patients (13.01%) had PLT counts <125×109/L at POM 3 after LSD, while the remaining 107 patients had normal counts. We analyzed 25 perioperative variables in both groups. A logistic multivariate regression identified age (relative risk [RR] 1.082, 95% confidence interval [CI] 1.018-1.150) and longitudinal spleen diameter (RR 0.977, 95% CI 0.955-1.000) as significant independent factors for the PLT count <125×109/L at POM 3. Bivariate correlation analysis showed that age >50 years and longitudinal spleen diameter <160 mm were threshold values for an increased risk of the PLT count <125×109/L at POM 3 after LSD.
Age was an independent positive predictor and longitudinal spleen diameter an independent negative predictor of PLT count <125×109/L at POM 3 after LSD.
背景/目的：脾切除术被视为治疗肝硬化患者脾功能亢进所致血小板减少症的有效治愈性疗法。然而，在临床实践中，并非所有患者的血小板减少症都能通过脾切除术得到解决。本研究旨在评估腹腔镜脾切除术联合奇静脉断流术（LSD）后血小板（PLT）计数低于正常下限的相关不利因素。
我们回顾性评估了2014年4月至2017年3月期间接受LSD且术后3个月血小板计数<125×10⁹/L（非正常组）或>125×10⁹/L（正常组）的123例肝硬化门静脉高压出血并继发性脾功能亢进患者的治疗结果。
16例患者（13.01%）在LSD术后3个月时血小板计数<125×10⁹/L，其余107例患者计数正常。我们分析了两组的25个围手术期变量。多因素逻辑回归分析确定年龄（相对危险度[RR]1.082，95%置信区间[CI]1.018 - 1.150）和脾脏纵径（RR 0.977，95%CI 0.955 - 1.000）是术后3个月血小板计数<125×10⁹/L的显著独立因素。双变量相关性分析表明，年龄>50岁和脾脏纵径<160 mm是LSD术后3个月血小板计数<125×10⁹/L风险增加的阈值。
年龄是LSD术后3个月血小板计数<125×10⁹/L的独立阳性预测因素，而脾脏纵径是独立阴性预测因素。
