CAJ | 학술논문

目的：探讨脾切断流术后门静脉血栓形成（PV T ）的危险因素及防治方法。方法回顾性分析2006年3月至2014年6月该院行脾切断流术的712例肝硬化门脉高压症患者的临床资料，分析术后发生 PV T 的危险因素和防治方法。结果 PV T发生率受年龄、肝功能等级、是否合并糖尿病和术后抗凝治疗，以及胃食管静脉曲张程度等5个因素影响。发生 PV T 的患者术前和术毕的门静脉压力及其差值均高于未发生 PV T 的患者（ P＜0．05）。发生 PVT 的患者血小板计数及D‐二聚体浓度均在术前到术后2周时增高，术后2周后开始降低，发生PV T的患者与未发生PV T的患者血小板计数差异无统计学意义（ P＞0．05），但在术后2～12周各时间点D‐二聚体浓度差异均有统计学意义（P＜0．05）。结论肝功能低下、糖尿病、年龄、胃食管静脉曲张程度、术后抗凝治疗、D‐二聚体浓度和门静脉压力是发生PV T的危险因素，术后积极改善危险因素对预防PV T形成有积极意义。
목적：탐토비절단류술후문정맥혈전형성（PV T ）적위험인소급방치방법。방법회고성분석2006년3월지2014년6월해원행비절단류술적712례간경화문맥고압증환자적림상자료，분석술후발생 PV T 적위험인소화방치방법。결과 PV T발생솔수년령、간공능등급、시부합병당뇨병화술후항응치료，이급위식관정맥곡장정도등5개인소영향。발생 PV T 적환자술전화술필적문정맥압력급기차치균고우미발생 PV T 적환자（ P＜0．05）。발생 PVT 적환자혈소판계수급D‐이취체농도균재술전도술후2주시증고，술후2주후개시강저，발생PV T적환자여미발생PV T적환자혈소판계수차이무통계학의의（ P＞0．05），단재술후2～12주각시간점D‐이취체농도차이균유통계학의의（P＜0．05）。결론간공능저하、당뇨병、년령、위식관정맥곡장정도、술후항응치료、D‐이취체농도화문정맥압력시발생PV T적위험인소，술후적겁개선위험인소대예방PV T형성유적겁의의。
Objective To investigate the risk factors and prophylactic methods for portal venous thrombosis (PVT ) after splenectomy and devascularization .Methods A retrospective analysis was performed on the clinical data in 712 cases of cirrhotic portal hypertension undergoing splenectomy and devascularization in our hospital from March 2006 to June 2014 .The risk factors of PVT occurrence after operation and prevention methods were analyzed .Results The occurrence rate of PVT was affected by the 5 factors of age ,liver function grade ,whether complicating diabe‐tes and postoperative anticoagulant therapy ,and gastroesophageal varices ,the differences were statistically significant (P<0 .05) .The portal venous pressure and its difference value before operation and at the end of operation in the pa‐tients with PVT occurrence were higher than those in the patients without PVT occurrence (P< 0 .05) .The PLT count and D‐dimer level in the patients with PVT occurrence were increased from before operation to postoperative 2 weeks and started to decrease from postoperative 2 weeks .The PLT count had no statistical difference between the patients with PVT occurrence and the patients without PVT occurrence (P>0 .05) ,but the D‐dimer levels had statis‐tical differences among various time points during postoperative 2-12 weeks(P>0 .05) .Conclusion Liver dysfunc‐tion ,diabetes ,age ,gastroesophageal varices degree and postoperative anticoagulant therapy ,D‐dimer level and portal venous pressure are the risk factors of PVT occurrence after splenectomy and devascularization ,actively improving the risk factors after operation has an active significance for the prevention of PVT .