CAJ | 학술논문

目的探讨监测P-选择素(P-selectin,P-sel)水平对门静脉高压症患者行脾脏切除(或联合血管断流)术后门静脉血栓(portal vein thrombosis,PVT)形成的早期预测价值.方法收集湖州市中心医院2009-2011年因门静脉高压行脾脏切除术患者48例,分为血栓组和非血栓组,通过连续监测术前1d及术后第1、3、5、7、14天的P-sel水平及血小板计数变化,用COX比例风险模型进行统计学分析.结果手术方式及P-sel水平是独立危险因素.P-sel指标每增加1个单位,PVT发生的风险是原来的1.03倍,而脾切除联合血管断流术后发生PVT的风险是单纯脾切除术的2.09倍.单纯脾切除术者,当P-sel值在12.73％～ 21.76％时,发生PVT的风险将增加50％～100％;对于联合血管断流术者,当P-sel值在7.00％～17.56％时亦会发生PVT.结论术后第1天检测P-sel水平对脾切除术后PVT的早期预测及防治具有积极意义.脾切除联合血管断流术较单纯脾切除术更易发生PVT.
목적 탐토감측P-선택소(P-selectin,P-sel)수평대문정맥고압증환자행비장절제(혹연합혈관단류)술후문정맥혈전(portal vein thrombosis,PVT)형성적조기예측개치.방법 수집호주시중심의원2009-2011년인문정맥고압행비장절제술환자48례,분위혈전조화비혈전조,통과련속감측술전1d급술후제1、3、5、7、14천적P-sel수평급혈소판계수변화,용COX비례풍험모형진행통계학분석.결과 수술방식급P-sel수평시독립위험인소.P-sel지표매증가1개단위,PVT발생적풍험시원래적1.03배,이비절제연합혈관단류술후발생PVT적풍험시단순비절제술적2.09배.단순비절제술자,당P-sel치재12.73％～ 21.76％시,발생PVT적풍험장증가50％～100％;대우연합혈관단류술자,당P-sel치재7.00％～17.56％시역회발생PVT.결론 술후제1천검측P-sel수평대비절제술후PVT적조기예측급방치구유적겁의의.비절제연합혈관단류술교단순비절제술경역발생PVT.
Objective To investigate the early predictive value of P-selectin (P-sel) level in portal vein thrombosis (PVT) of portal hypertensive patients after splenectomy.Methods 48 patients with portal hypertension undergoing splenectomy in our hospital from 2009 to 2011 were divided into PVT group and non-PVT group.Time-dependent covariate COX's proportional hazard model was used to detect the P-sel,and platelet levels of the two groups on preoperative day 1 and postoperative day 1,3,5,7,14 dynamically.Results Operation methods and P-sel were independent factors for PVT.The risk of PVT was 1.03 times when P-sel increased one unit,and the risk of splenectomy associated with devascularization was 2.09 times as splenectomy.The risk of PVT increases 50％-100％ when P-sel in 12.73％-21.76％ in splenectomy cases.In cases of splenectomy associated with gastroesophageal devascularization there is a risk for post-op PVT when P-sel was in 7.00％-17.56％.Conclusions It was very.helpful to predict PVT after splenectomy by checking P-sel on postoperative day 1.PVT occurred more likely in splenectomy associated with devascularization than in splenectomy only.