CAJ | 학술논문

目的：分析肝移植术后持续性血小板减少的危险因素，探索减少该疾病发生的有效治疗手段。方法：回顾性分析在浙江大学医学院附属第一医院肝胆胰外科2009年1月—2012年6月期间接受肝移植手术并符合纳入标准的128例患者资料，对移植前脾脏体积、术前门静脉直径、术前胃左静脉直径、术前和术后血小板、术前和术后白细胞、术前总胆红素水平及终末期肝病模型评分等指标进行统计分析，筛选术后持续性血小板减少的独立危险因素。并且对在2012—2013年期间部分术前存在危险因素的患者行肝移植同期脾动脉缩窄术，分析其术后持续性血小板减少的发生率。结果：患者肝移植术前脾脏体积大于500 ml （ P＝0.012， OR＝2.789，95％可信区间：1.249～6.227）以及门静脉直径大于15 mm （ P ＝0.017， OR＝3.124，95％可信区间：1.230～7.933）为术后持续性血小板减少的独立危险因素。行肝移植同期脾动脉缩窄术的6例患者中仅1例（16.7％）在术后表现为持续性血小板减少，而对照组48例中32例（66.7％）术后存在持续性血小板减少，两者间差异有统计学意义（ P＜0.05）。结论：患者肝移植术前脾脏体积大于500 ml以及门静脉直径大于15 mm可以作为肝移植术后持续性血小板减少的独立危险因素。肝移植手术同期行脾动脉缩窄术以控制脾脏体积作为肝移植术后持续性血小板减少的预防方法具有一定的临床效果。
목적：분석간이식술후지속성혈소판감소적위험인소，탐색감소해질병발생적유효치료수단。방법：회고성분석재절강대학의학원부속제일의원간담이외과2009년1월—2012년6월기간접수간이식수술병부합납입표준적128례환자자료，대이식전비장체적、술전문정맥직경、술전위좌정맥직경、술전화술후혈소판、술전화술후백세포、술전총담홍소수평급종말기간병모형평분등지표진행통계분석，사선술후지속성혈소판감소적독립위험인소。병차대재2012—2013년기간부분술전존재위험인소적환자행간이식동기비동맥축착술，분석기술후지속성혈소판감소적발생솔。결과：환자간이식술전비장체적대우500 ml （ P＝0.012， OR＝2.789，95％가신구간：1.249～6.227）이급문정맥직경대우15 mm （ P ＝0.017， OR＝3.124，95％가신구간：1.230～7.933）위술후지속성혈소판감소적독립위험인소。행간이식동기비동맥축착술적6례환자중부1례（16.7％）재술후표현위지속성혈소판감소，이대조조48례중32례（66.7％）술후존재지속성혈소판감소，량자간차이유통계학의의（ P＜0.05）。결론：환자간이식술전비장체적대우500 ml이급문정맥직경대우15 mm가이작위간이식술후지속성혈소판감소적독립위험인소。간이식수술동기행비동맥축착술이공제비장체적작위간이식술후지속성혈소판감소적예방방법구유일정적림상효과。
Objective: To investigate the risk factors associated with persistent thrombocytopenia after liver transplantation ( LT) , and to explore effective measures for prevention.Methods:One hundred and twenty-eight adult patients, who received liver transplantation in our hospital between January 2009 and June 2012 and met the inclusive criteria, were enrolled in the study.The clinical data were retrospectively analyzed, including pre-LT spleen volume, main portal vein size, coronary vein size, platelet and white blood cell levels, total bilirubin level and model of end stage liver disease score.The risk factors associated with persistent thrombocytopenia after LT were evaluated by logistic regression analysis. The effect of simultaneous splenic artery coarctation for high risk patients was evaluated withχ2 test.Results:Logistic regression analysis showed that per-LT spleen volume larger than 500 ml ( P =0.012, OR=2.789, 95%CI: 1.249 -6.227 ) and portal vein size beyond 15 mm ( P =0.017, OR =3.124, 95%CI: 1.230 -7.933 ) were independent risk factors for persistent thrombocytopenia after LT.The incidence rate of persistent thrombocytopenia after LT in patients with or without simultaneous splenic artery coarctation were 16.7%(1/6) and 66.7% (32/48), respectively(P<0.05).Conclusion: Spleen volume larger than 500 ml and portal vein size beyond 15 mm are risk factors for persistent thrombocytopenia after LT.Simultaneous splenic artery coarctation may reduce the occurrence of persistent thrombocytopenia after LT.