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.	張靜, 陳明鍇. 門脈高壓癥的診斷與治療進展. 胃腸病學和肝病學雜志, 2018, 27(3): 341-345.
4.	王昊, 李亭, 賀志軍. 肝硬化食管胃底靜脈曲張破裂出血的綜合治療. 中國普通外科雜志, 2019, 28(1): 107-116.
5.	吳洪偉. 脾切除聯合門脈斷流術對肝硬化門脈高壓患者血細胞水平及肝功能的影響. 包頭醫學院學報, 2017, 33(8): 29-31.
6.	孫思楠, 李建生, 余繼海, 等. 選擇性賁門周圍血管離斷術聯合脾切除術治療門靜脈高壓癥的臨床評價. 肝膽外科雜志, 2017, 25(6): 416-418.
7.	馬千云. 脾切除聯合賁門周圍血管離斷術治療肝硬化門靜脈高壓癥. 中南醫學科學雜志, 2018, 46(2): 172-175.
8.	楊鎮, 萬赤丹, 鄧小榮. 腹腔鏡門靜脈高壓癥外科治療發展與新斷流術. 中華普外科手術學雜志(電子版), 2017, 11(3): 181-184.
9.	徐繼威, 張耀明, 宋越, 等. 完全腹腔鏡下脾切除聯合賁門周圍血管離斷術治療門脈高壓癥. 中國微創外科雜志, 2015, 15(7): 601-603.
10.	劉秀荃, 張新宇. 腹腔鏡脾切除術的研究進展. 中國普外基礎與臨床雜志, 2018, 25(1): 113-117.
11.	王繼才, 劉志發, 蘇志雷, 等. 腹腔鏡與開腹手術治療門靜脈高壓癥的臨床效果分析. 中華普外科手術雜志學(電子版), 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.	韓丹, 祁興順, 于洋, 等. 《2016年美國肝病學會肝硬化門靜脈高壓出血的風險分層、診斷和管理實踐指導》摘譯. 臨床肝膽病雜志, 2017, 33(3): 422-427.
14.	中華醫學會肝病學分會, 中華醫學會消化病學分會, 中華醫學會消化內鏡學分. 肝硬化門靜脈高壓食管胃靜脈曲張出血的防治指南. 中華內科雜志, 2016, 55(1): 57-72.
15.	劉治智, 李巍. Child-Pugh與Rockall評分評估肝硬化失代償期上消化道出血短期預后價值比較. 浙江中西醫結合雜志, 2008, 28(12): 1021-1023.
16.	M?ller 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.	馬靖, 王衛東, 劉清波, 等. 腹腔鏡下賁門周圍血管離斷術后大出血再次腔鏡探查止血1例. 中國微創外科雜志, 2018, 18(11): 1040-1042.
19.	曲凱, 劉昌. 冠腔分流術治療門靜脈高壓癥上消化道出血—40年內國內報道病例分析. 中華肝臟外科手術學電子雜志, 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, 高鵬驥, 高杰, 等. 肝移植治療肝硬化門靜脈高壓癥. 中華消化外科雜志, 2014, 13(9): 683-686.
22.	Berzigotti A. Advances and challenges in cirrhosis and portal hypertension. BMC Med, 2017, 15(1): 200.
23.	李濤, 楊鎮. 精準醫學時代門靜脈高壓癥新斷流術的進展. 臨床外科雜志, 2017, 25(1): 30-31, 32.
24.	洪若豐, 黎一鳴, 陸宏偉, 等. 門靜脈高壓癥患者行脾切除術對肝癌發生及復發影響的研究進展. 中國普外基礎與臨床雜志, 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.	郭雅麗, 徐寶宏, 劉賢, 等. 食管靜脈曲張內鏡治療術后早期再出血的危險因素分析. 中華消化內鏡雜志, 2018, 35(2): 89-93.
29.	馬千云. 肝硬化門靜脈高壓癥行脾切除賁門周圍血管離斷術后再出血的二級預防價值. 湖南師范大學學報(醫學版), 2017, 14(2): 177-180.
30.	溫軍業, 范曉燕, 左慶娟, 等. 門靜脈高壓患者行脾切除賁門周圍血管離斷的并發癥防治策略. 河北醫藥, 2018, 40(18): 2847-2850.
31.	趙曉飛, 林棟棟, 李寧. 門靜脈高壓患者脾切斷流術后曲張靜脈再出血的危險因素分析. 臨床肝膽病雜志, 2018, 34(10): 2182-2185.
32.	張書俊. 選擇性斷流術和聯合斷流術治療門脈高壓癥的比較研究. 中國現代醫學雜志, 2014, 24(36): 101-104.
33.	朱青川, 侯麗華, 潘誠志. 血清白蛋白、前白蛋白、轉鐵蛋白在慢性肝功能衰竭患者中的作用和對預后的影響. 醫療裝備, 2018, 31(21): 60-62.
34.	宋珂達, 姜洪池. 門靜脈壓力無創測定應給予重視. 中華普通外科學文獻(電子版), 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. 張靜, 陳明鍇. 門脈高壓癥的診斷與治療進展. 胃腸病學和肝病學雜志, 2018, 27(3): 341-345.
4. 王昊, 李亭, 賀志軍. 肝硬化食管胃底靜脈曲張破裂出血的綜合治療. 中國普通外科雜志, 2019, 28(1): 107-116.
5. 吳洪偉. 脾切除聯合門脈斷流術對肝硬化門脈高壓患者血細胞水平及肝功能的影響. 包頭醫學院學報, 2017, 33(8): 29-31.
6. 孫思楠, 李建生, 余繼海, 等. 選擇性賁門周圍血管離斷術聯合脾切除術治療門靜脈高壓癥的臨床評價. 肝膽外科雜志, 2017, 25(6): 416-418.
7. 馬千云. 脾切除聯合賁門周圍血管離斷術治療肝硬化門靜脈高壓癥. 中南醫學科學雜志, 2018, 46(2): 172-175.
8. 楊鎮, 萬赤丹, 鄧小榮. 腹腔鏡門靜脈高壓癥外科治療發展與新斷流術. 中華普外科手術學雜志(電子版), 2017, 11(3): 181-184.
9. 徐繼威, 張耀明, 宋越, 等. 完全腹腔鏡下脾切除聯合賁門周圍血管離斷術治療門脈高壓癥. 中國微創外科雜志, 2015, 15(7): 601-603.
10. 劉秀荃, 張新宇. 腹腔鏡脾切除術的研究進展. 中國普外基礎與臨床雜志, 2018, 25(1): 113-117.
11. 王繼才, 劉志發, 蘇志雷, 等. 腹腔鏡與開腹手術治療門靜脈高壓癥的臨床效果分析. 中華普外科手術雜志學(電子版), 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. 韓丹, 祁興順, 于洋, 等. 《2016年美國肝病學會肝硬化門靜脈高壓出血的風險分層、診斷和管理實踐指導》摘譯. 臨床肝膽病雜志, 2017, 33(3): 422-427.
14. 中華醫學會肝病學分會, 中華醫學會消化病學分會, 中華醫學會消化內鏡學分. 肝硬化門靜脈高壓食管胃靜脈曲張出血的防治指南. 中華內科雜志, 2016, 55(1): 57-72.
15. 劉治智, 李巍. Child-Pugh與Rockall評分評估肝硬化失代償期上消化道出血短期預后價值比較. 浙江中西醫結合雜志, 2008, 28(12): 1021-1023.
16. M?ller 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. 馬靖, 王衛東, 劉清波, 等. 腹腔鏡下賁門周圍血管離斷術后大出血再次腔鏡探查止血1例. 中國微創外科雜志, 2018, 18(11): 1040-1042.
19. 曲凱, 劉昌. 冠腔分流術治療門靜脈高壓癥上消化道出血—40年內國內報道病例分析. 中華肝臟外科手術學電子雜志, 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, 高鵬驥, 高杰, 等. 肝移植治療肝硬化門靜脈高壓癥. 中華消化外科雜志, 2014, 13(9): 683-686.
22. Berzigotti A. Advances and challenges in cirrhosis and portal hypertension. BMC Med, 2017, 15(1): 200.
23. 李濤, 楊鎮. 精準醫學時代門靜脈高壓癥新斷流術的進展. 臨床外科雜志, 2017, 25(1): 30-31, 32.
24. 洪若豐, 黎一鳴, 陸宏偉, 等. 門靜脈高壓癥患者行脾切除術對肝癌發生及復發影響的研究進展. 中國普外基礎與臨床雜志, 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. 郭雅麗, 徐寶宏, 劉賢, 等. 食管靜脈曲張內鏡治療術后早期再出血的危險因素分析. 中華消化內鏡雜志, 2018, 35(2): 89-93.
29. 馬千云. 肝硬化門靜脈高壓癥行脾切除賁門周圍血管離斷術后再出血的二級預防價值. 湖南師范大學學報(醫學版), 2017, 14(2): 177-180.
30. 溫軍業, 范曉燕, 左慶娟, 等. 門靜脈高壓患者行脾切除賁門周圍血管離斷的并發癥防治策略. 河北醫藥, 2018, 40(18): 2847-2850.
31. 趙曉飛, 林棟棟, 李寧. 門靜脈高壓患者脾切斷流術后曲張靜脈再出血的危險因素分析. 臨床肝膽病雜志, 2018, 34(10): 2182-2185.
32. 張書俊. 選擇性斷流術和聯合斷流術治療門脈高壓癥的比較研究. 中國現代醫學雜志, 2014, 24(36): 101-104.
33. 朱青川, 侯麗華, 潘誠志. 血清白蛋白、前白蛋白、轉鐵蛋白在慢性肝功能衰竭患者中的作用和對預后的影響. 醫療裝備, 2018, 31(21): 60-62.
34. 宋珂達, 姜洪池. 門靜脈壓力無創測定應給予重視. 中華普通外科學文獻(電子版), 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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