Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou, 570311 Hainan Province, China.
Reproductive Medicine Center of Hainan Women and Children's Medical Center, Haikou, 570206 Hainan Province, China.
Dis Markers. 2023 Jun 7;2023:5560560. doi: 10.1155/2023/5560560. eCollection 2023.
Patients with cirrhosis and splenomegaly often have coagulation dysfunction which affects treatment and prognosis. This study explores the status, grading, and treatment strategies of coagulation dysfunction in patients with liver cirrhosis and splenomegaly.
A retrospective cohort study was conducted on the clinical data on consecutive patients with cirrhosis and splenomegaly treated at Hainan General Hospital, China, from January 2000 to December 2020. Starting research in January 2022.
Among 1522 patients included into this study, 297 (19.5%) patients had normal results in all five coagulation tests (prothrombin time, prothrombin activity, activated partial thromboplastin time, thrombin time, and fibrinogen), and 1225 (80.5%) had coagulation dysfunction in at least one of these tests. There were significant differences ( < 0.05) in treatment efficacy on these patients for three of these five coagulation tests, with the exception of prothrombin activity and thrombin time. When coagulation dysfunction was classified into grades I, II, and III based on scores from the three significant coagulation tests, prothrombin time, activated partial thromboplastin time, and fibrinogen, significant differences in surgical outcomes were found among the three grades of coagulation dysfunction and between grades I and III ( < 0.05). The operative mortality rate in patients with grade III in treating liver cancer, portal hypersplenism, and/or splenomegaly was 6.5%. There was no significant difference between patients with grades I and II ( > 0.05).
Approximately, 80% of patients with liver cirrhosis and splenomegaly had coagulation dysfunction. Surgery is feasible for grade I and II patients. For grade III patients, nonsurgical treatment should be given first, and surgery should only be considered when the coagulation function returns to normal or near-normal levels after treatment. This trial is registered with MR-46-22-009299.
肝硬化伴脾肿大患者常伴有凝血功能障碍，影响治疗和预后。本研究探讨了肝硬化伴脾肿大患者凝血功能障碍的现状、分级及治疗策略。
回顾性分析 2000 年 1 月至 2020 年 12 月海南医院连续收治的肝硬化伴脾肿大患者的临床资料，研究于 2022 年 1 月开始。
本研究共纳入 1522 例患者，297 例（19.5%）患者五项凝血检测（凝血酶原时间、凝血酶原活动度、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原）均正常，1225 例（80.5%）至少一项凝血检测异常。除凝血酶原活性和凝血酶时间外，这五项凝血检测中，有三项凝血检测的治疗效果存在显著差异（<0.05）。根据凝血酶原时间、活化部分凝血活酶时间和纤维蛋白原这三项显著的凝血检测结果将凝血功能障碍分为 I 级、II 级和 III 级，发现三组患者的手术结果存在显著差异，且 I 级与 III 级之间也存在显著差异（<0.05）。治疗肝癌、门静脉高压症和（或）脾肿大时，III 级患者的手术死亡率为 6.5%。I 级和 II 级患者之间无显著差异（>0.05）。
约 80%的肝硬化伴脾肿大患者存在凝血功能障碍。I 级和 II 级患者可行手术治疗。III 级患者应首先给予非手术治疗，仅在治疗后凝血功能恢复正常或接近正常水平时考虑手术治疗。本试验已在 MR-46-22-009299 注册。
