门静脉高压症脾切除联合贲门周围血管离断术后消化道再出血的危险因素分析

目的探讨门静脉高压症行脾切除联合贲门周围血管离断术后消化道再出血的危险因素。方法回顾性分析2008年1月至2011年6月西安交通大学医学院第一附属医院收治的117例门静脉高压症行脾切除联合贲门周围血管离断术患者的临床资料，其中22例术后再次发生上消化道出血。患者术后半年内每3个月随访1次，半年后每6个月随访1次，随访时间截至2013年3月。单因素分析采用，检验，多因素分析采用Logistic回归模型。结果患者术后随访时间为20．6～61．7个月，术后上消化道再出血发生率为18．80％（22／117）。单因素分析结果显示：乙型病毒性肝炎病史、术前AST、术前食管胃底静脉曲张、术后l周PLT、术后门静脉血栓是术后消化道再出血的危险因素（X2=7．326，5．290，10．112，4．020，9．239，P〈0．05）。多因素分析结果显示：乙型病毒性肝炎病史≥10年、术前食管胃底静脉3度曲张、术后门静脉血栓是术后消化道再出血的独立危险因素（OR=4．758，5．560，3．616，P〈0．05）。结论乙型病毒性肝炎病史≥10年、食管胃底静脉3度曲张及术后门静脉血栓是乙型病毒性肝炎肝硬化脾切除断流术后的独立危险因素。

Risk factors for recurrent gastrointestinal hemorrhage after splenectomy plus pericardial devascularization for patients with portal hypertension

Objective To investigate the risk factors for recurrent gastrointestinal hemorrhage after splenectomy plus perieardial devascularization for patients with portal hypertension. Methods The clinical data of 117 patients with HBV induced liver cirrhosis who received splenectomy plus perieardial devascularization at the First Affiliated Hospital of Xi＇an Jiaotong University from January 2008 to June 2011 were retrospectively analyzed. There were 22 patients had gastrointestinal bleeding postoperatively. Factors associated with postoperative gastroin- testinal re-bleeding were analyzed to screen out the related risk factors. Univariate and muhivariate analysis were done by chi-square test and Logistic regression model, respectively. Results All the patients were followed up for 20.6-61.7 months after the operation, and the incidence of postoperative gastrointestinal re-bleeding was 18.80% （22/117）. The results of univariate analysis showed that HBV infection, preoperative level of aspartate amin- otransferase （ AST）, degree of esophagogastrie varices, platelet count on postoperative day 7 and postoperative portal vein thrombosis were risk factors of postoperative gastrointestinal re-bleeding （X2= 7. 326, 5. 290, 10. 112, 4. 020, 9. 239, P 〈 0.05 ）. The results of multivariate analysis showed that the history of HBV infection more than 10 years, esophageal varices （3rd dgree） , postoperative portal vein thrombosis were the independent risk factors of postoperative gastrointestinal re-bleeding （ OR = 4. 758, 5. 560, 3. 616, P 〈 0.05）. Conclusions History of HBV infection more than 10 years, severe esophageal variees （3rd degree） and postoperative portal vein thrombosis are the independent risk factors of gastrointestinal bleeding after spleneetomy plus perieardial devaseularization. Metic- ulous monitoring of individuals with the risk factors are warranted in order to ameliorate the prognosis.