Multivariate regression analysis of rebleeding related factors after laparoscopic selective pericardial devascularization combined with splenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Kang ^1,2 ,  ZHOU Jun ² , LEI Ting ² , JIA Zipei ¹

1. Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712046, P. R. China;
2. Department of General Surgery, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712000, P. R. China;

Corresponding author：

ZHOU Jun, Email: 13629106789@163.com

Keywords：

portal hypertension; selective pericardial devascularization combined with splenectomy; rebleeding

DOI：

10.7507/1007-9424.201902061

Video：

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Objective To analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy.Methods The clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group (n=20) and the non-bleeding group (n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding.Results The rebleeding occurred in 20 of 147 patients (13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the non-bleeding group (P<0.050). The classification of liver function ［OR=3.444, 95% CI (1.211. 9.793）, P=0.020］, ascites ［OR=2.859, 95% CI (1.069, 7.645), P=0.036］, hepatic encephalopathy ［OR=4.265, 95% CI（1.121, 16.230）, P=0.033］, and portal hypertensive gastropathy ［OR=6.744, 95% CI (1.675, 27.156), P=0.007］, and platelet count ［OR=4.744, 95% CI (1.073, 20.969), P=0.040］ were the independent factors for the postoperative rebleeding by the logistic regression analysis.Conclusion For patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.

Citation： ZHANG Kang, ZHOU Jun, LEI Ting, JIA Zipei. Multivariate regression analysis of rebleeding related factors after laparoscopic selective pericardial devascularization combined with splenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 798-802. doi: 10.7507/1007-9424.201902061 Copy

1.	Patrono D, Benvenga R, Moro F, et al. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization. Int J Surg Case Rep, 2014, 5(10): 652-655.
2.	Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1): 310-335.
3.	张静, 陈明锴. 门脉高压症的诊断与治疗进展. 胃肠病学和肝病学杂志, 2018, 27(3): 341-345.
4.	王昊, 李亭, 贺志军. 肝硬化食管胃底静脉曲张破裂出血的综合治疗. 中国普通外科杂志, 2019, 28(1): 107-116.
5.	吴洪伟. 脾切除联合门脉断流术对肝硬化门脉高压患者血细胞水平及肝功能的影响. 包头医学院学报, 2017, 33(8): 29-31.
6.	孙思楠, 李建生, 余继海, 等. 选择性贲门周围血管离断术联合脾切除术治疗门静脉高压症的临床评价. 肝胆外科杂志, 2017, 25(6): 416-418.
7.	马千云. 脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症. 中南医学科学杂志, 2018, 46(2): 172-175.
8.	杨镇, 万赤丹, 邓小荣. 腹腔镜门静脉高压症外科治疗发展与新断流术. 中华普外科手术学杂志(电子版), 2017, 11(3): 181-184.
9.	徐继威, 张耀明, 宋越, 等. 完全腹腔镜下脾切除联合贲门周围血管离断术治疗门脉高压症. 中国微创外科杂志, 2015, 15(7): 601-603.
10.	刘秀荃, 张新宇. 腹腔镜脾切除术的研究进展. 中国普外基础与临床杂志, 2018, 25(1): 113-117.
11.	王继才, 刘志发, 苏志雷, 等. 腹腔镜与开腹手术治疗门静脉高压症的临床效果分析. 中华普外科手术杂志学(电子版), 2017, 11(3): 193-197.
12.	Zheng S, Sun P, Liu X, et al. Efficacy and safety of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension: A single-center experience. Medicine (Baltimore), 2018, 97(50): e13703.
13.	韩丹, 祁兴顺, 于洋, 等. 《2016年美国肝病学会肝硬化门静脉高压出血的风险分层、诊断和管理实践指导》摘译. 临床肝胆病杂志, 2017, 33(3): 422-427.
14.	中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 中华内科杂志, 2016, 55(1): 57-72.
15.	刘治智, 李巍. Child-Pugh与Rockall评分评估肝硬化失代偿期上消化道出血短期预后价值比较. 浙江中西医结合杂志, 2008, 28(12): 1021-1023.
16.	Møller S, Bendtsen F. The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis. Liver Int, 2018, 38(4): 570-580.
17.	Turon F, Casu S, Hernández-Gea V, et al. Variceal and other portal hypertension related bleeding. Best Pract Res Clin Gastroenterol, 2013, 27(5): 649-664.
18.	马靖, 王卫东, 刘清波, 等. 腹腔镜下贲门周围血管离断术后大出血再次腔镜探查止血1例. 中国微创外科杂志, 2018, 18(11): 1040-1042.
19.	曲凯, 刘昌. 冠腔分流术治疗门静脉高压症上消化道出血—40年内国内报道病例分析. 中华肝脏外科手术学电子杂志, 2017, 6(2): 113-117.
20.	Komori K, Kubokawa M, Ihara E, et al. Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding. World J Gastroenterol, 2017, 23(3): 496-504.
21.	李照, 高鹏骥, 高杰, 等. 肝移植治疗肝硬化门静脉高压症. 中华消化外科杂志, 2014, 13(9): 683-686.
22.	Berzigotti A. Advances and challenges in cirrhosis and portal hypertension. BMC Med, 2017, 15(1): 200.
23.	李涛, 杨镇. 精准医学时代门静脉高压症新断流术的进展. 临床外科杂志, 2017, 25(1): 30-31, 32.
24.	洪若丰, 黎一鸣, 陆宏伟, 等. 门静脉高压症患者行脾切除术对肝癌发生及复发影响的研究进展. 中国普外基础与临床杂志, 2018, 25(1): 104-107.
25.	Wang MT, Liu T, Ma XQ, et al. Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding. Chin Med J (Engl), 2011, 124(10): 1493-1497.
26.	Lee SW, Lee TY, Chang CS. Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage. Dig Dis Sci, 2009, 54(5): 1128-1134.
27.	Hejda V. Late complications of liver cirrhosis—management of gastrointestinal bleeding in the presence of portal hypertension. Vnitr Lek, Fall, 2016, 62(9 Suppl 2): 10-17.
28.	郭雅丽, 徐宝宏, 刘贤, 等. 食管静脉曲张内镜治疗术后早期再出血的危险因素分析. 中华消化内镜杂志, 2018, 35(2): 89-93.
29.	马千云. 肝硬化门静脉高压症行脾切除贲门周围血管离断术后再出血的二级预防价值. 湖南师范大学学报(医学版), 2017, 14(2): 177-180.
30.	温军业, 范晓燕, 左庆娟, 等. 门静脉高压患者行脾切除贲门周围血管离断的并发症防治策略. 河北医药, 2018, 40(18): 2847-2850.
31.	赵晓飞, 林栋栋, 李宁. 门静脉高压患者脾切断流术后曲张静脉再出血的危险因素分析. 临床肝胆病杂志, 2018, 34(10): 2182-2185.
32.	张书俊. 选择性断流术和联合断流术治疗门脉高压症的比较研究. 中国现代医学杂志, 2014, 24(36): 101-104.
33.	朱青川, 侯丽华, 潘诚志. 血清白蛋白、前白蛋白、转铁蛋白在慢性肝功能衰竭患者中的作用和对预后的影响. 医疗装备, 2018, 31(21): 60-62.
34.	宋珂达, 姜洪池. 门静脉压力无创测定应给予重视. 中华普通外科学文献(电子版), 2018, 12(6): 373-375.

1. Patrono D, Benvenga R, Moro F, et al. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization. Int J Surg Case Rep, 2014, 5(10): 652-655.
2. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1): 310-335.
3. 张静, 陈明锴. 门脉高压症的诊断与治疗进展. 胃肠病学和肝病学杂志, 2018, 27(3): 341-345.
4. 王昊, 李亭, 贺志军. 肝硬化食管胃底静脉曲张破裂出血的综合治疗. 中国普通外科杂志, 2019, 28(1): 107-116.
5. 吴洪伟. 脾切除联合门脉断流术对肝硬化门脉高压患者血细胞水平及肝功能的影响. 包头医学院学报, 2017, 33(8): 29-31.
6. 孙思楠, 李建生, 余继海, 等. 选择性贲门周围血管离断术联合脾切除术治疗门静脉高压症的临床评价. 肝胆外科杂志, 2017, 25(6): 416-418.
7. 马千云. 脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症. 中南医学科学杂志, 2018, 46(2): 172-175.
8. 杨镇, 万赤丹, 邓小荣. 腹腔镜门静脉高压症外科治疗发展与新断流术. 中华普外科手术学杂志(电子版), 2017, 11(3): 181-184.
9. 徐继威, 张耀明, 宋越, 等. 完全腹腔镜下脾切除联合贲门周围血管离断术治疗门脉高压症. 中国微创外科杂志, 2015, 15(7): 601-603.
10. 刘秀荃, 张新宇. 腹腔镜脾切除术的研究进展. 中国普外基础与临床杂志, 2018, 25(1): 113-117.
11. 王继才, 刘志发, 苏志雷, 等. 腹腔镜与开腹手术治疗门静脉高压症的临床效果分析. 中华普外科手术杂志学(电子版), 2017, 11(3): 193-197.
12. Zheng S, Sun P, Liu X, et al. Efficacy and safety of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension: A single-center experience. Medicine (Baltimore), 2018, 97(50): e13703.
13. 韩丹, 祁兴顺, 于洋, 等. 《2016年美国肝病学会肝硬化门静脉高压出血的风险分层、诊断和管理实践指导》摘译. 临床肝胆病杂志, 2017, 33(3): 422-427.
14. 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 中华内科杂志, 2016, 55(1): 57-72.
15. 刘治智, 李巍. Child-Pugh与Rockall评分评估肝硬化失代偿期上消化道出血短期预后价值比较. 浙江中西医结合杂志, 2008, 28(12): 1021-1023.
16. Møller S, Bendtsen F. The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis. Liver Int, 2018, 38(4): 570-580.
17. Turon F, Casu S, Hernández-Gea V, et al. Variceal and other portal hypertension related bleeding. Best Pract Res Clin Gastroenterol, 2013, 27(5): 649-664.
18. 马靖, 王卫东, 刘清波, 等. 腹腔镜下贲门周围血管离断术后大出血再次腔镜探查止血1例. 中国微创外科杂志, 2018, 18(11): 1040-1042.
19. 曲凯, 刘昌. 冠腔分流术治疗门静脉高压症上消化道出血—40年内国内报道病例分析. 中华肝脏外科手术学电子杂志, 2017, 6(2): 113-117.
20. Komori K, Kubokawa M, Ihara E, et al. Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding. World J Gastroenterol, 2017, 23(3): 496-504.
21. 李照, 高鹏骥, 高杰, 等. 肝移植治疗肝硬化门静脉高压症. 中华消化外科杂志, 2014, 13(9): 683-686.
22. Berzigotti A. Advances and challenges in cirrhosis and portal hypertension. BMC Med, 2017, 15(1): 200.
23. 李涛, 杨镇. 精准医学时代门静脉高压症新断流术的进展. 临床外科杂志, 2017, 25(1): 30-31, 32.
24. 洪若丰, 黎一鸣, 陆宏伟, 等. 门静脉高压症患者行脾切除术对肝癌发生及复发影响的研究进展. 中国普外基础与临床杂志, 2018, 25(1): 104-107.
25. Wang MT, Liu T, Ma XQ, et al. Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding. Chin Med J (Engl), 2011, 124(10): 1493-1497.
26. Lee SW, Lee TY, Chang CS. Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage. Dig Dis Sci, 2009, 54(5): 1128-1134.
27. Hejda V. Late complications of liver cirrhosis—management of gastrointestinal bleeding in the presence of portal hypertension. Vnitr Lek, Fall, 2016, 62(9 Suppl 2): 10-17.
28. 郭雅丽, 徐宝宏, 刘贤, 等. 食管静脉曲张内镜治疗术后早期再出血的危险因素分析. 中华消化内镜杂志, 2018, 35(2): 89-93.
29. 马千云. 肝硬化门静脉高压症行脾切除贲门周围血管离断术后再出血的二级预防价值. 湖南师范大学学报(医学版), 2017, 14(2): 177-180.
30. 温军业, 范晓燕, 左庆娟, 等. 门静脉高压患者行脾切除贲门周围血管离断的并发症防治策略. 河北医药, 2018, 40(18): 2847-2850.
31. 赵晓飞, 林栋栋, 李宁. 门静脉高压患者脾切断流术后曲张静脉再出血的危险因素分析. 临床肝胆病杂志, 2018, 34(10): 2182-2185.
32. 张书俊. 选择性断流术和联合断流术治疗门脉高压症的比较研究. 中国现代医学杂志, 2014, 24(36): 101-104.
33. 朱青川, 侯丽华, 潘诚志. 血清白蛋白、前白蛋白、转铁蛋白在慢性肝功能衰竭患者中的作用和对预后的影响. 医疗装备, 2018, 31(21): 60-62.
34. 宋珂达, 姜洪池. 门静脉压力无创测定应给予重视. 中华普通外科学文献(电子版), 2018, 12(6): 373-375.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multivariate regression analysis of rebleeding related factors after laparoscopic selective pericardial devascularization combined with splenectomy

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