發(fā)布時(shí)間：2018-08-19 15:31

【摘要】：目的系統(tǒng)評價(jià)肝硬化門脈高壓癥病人行斷流術(shù)后門靜脈系統(tǒng)形成血栓的有關(guān)因素,為斷流術(shù)后避免門靜脈系統(tǒng)形成血栓提供指導(dǎo)。方法使用計(jì)算機(jī)文獻(xiàn)檢索PubMed、EMBASE、Cochrane圖書館、中國知網(wǎng)、萬方數(shù)據(jù)庫、維普、CBM,檢索自建庫至2016年09月發(fā)表的所有關(guān)于斷流術(shù)后門靜脈血栓形成危險(xiǎn)因素的病例對照研究,分別由2名研究者通過雙人獨(dú)立評審按照排除標(biāo)準(zhǔn)進(jìn)行文獻(xiàn)篩選并提取數(shù)據(jù),采用Rev Man 5.3統(tǒng)計(jì)軟件進(jìn)行Meta分析。結(jié)果共納入9篇符合標(biāo)準(zhǔn)的病例對照研究,病例數(shù)為2105例,其中,門靜脈血栓發(fā)生676例,發(fā)生率為32.11%。Meta分析結(jié)果顯示,斷流術(shù)后門靜脈血栓形成與病人術(shù)后門靜脈直徑(MD=1.70,95%CI:0.07~3.34)、術(shù)后門靜脈流速(MD=-4.98,95%CI:-5.62~-4.33)、術(shù)前血小板計(jì)數(shù)(MD=-17.09,95%CI:-29.09~-5.09)、術(shù)中出血量(MD=137.26,95%CI:55.01~219.52)有關(guān),而與病人性別、年齡、肝功能Child-Pugh分級、是否合并糖尿病、脾臟質(zhì)量、術(shù)后1周血小板、術(shù)后凝血酶原時(shí)間、術(shù)前門靜脈流速無關(guān)。結(jié)論肝硬化門脈高壓癥病人行斷流術(shù)后門靜脈血栓形成的危險(xiǎn)因素是術(shù)后門靜脈直徑增寬、術(shù)后門靜脈流速降低、術(shù)前較低的血小板計(jì)數(shù)、術(shù)中出血量多等,其發(fā)病與病人性別、年齡、肝功能Child-Pugh分級、是否合并糖尿病、脾臟質(zhì)量、術(shù)后1周血小板計(jì)數(shù)、術(shù)后凝血酶原時(shí)間、術(shù)前門靜脈流速無直接相關(guān)性。
[Abstract]:Objective to evaluate the relevant factors of portal vein thrombosis after devascularization in cirrhotic portal hypertension patients, and to provide guidance for avoiding portal vein thrombosis after devascularization. Methods A computer-based literature was used to search the PubMedus EMBASE Cochrane Library, China knowledge Network, Wanfang Database, Wiper CBM, and all the case-control studies published up to September 2016 on the risk factors of portal vein thrombosis after devascularization. The data were screened and extracted by two researchers by double independent review according to the exclusion criteria, and Meta analysis was carried out by Rev Man 5.3 statistical software. Results 2105 cases were included in 9 Case-control studies, including 676 cases of portal vein thrombosis, the incidence of which was revealed by 32.11%.Meta analysis. Portal vein thrombosis after devascularization was related to the postoperative portal vein diameter (MDN 1.7095 CI: 0.07 / 3.34), postoperative portal vein velocity (MD-4.98-95CI-5.62C -4.33), preoperative platelet count (MD-17.09 ~ 95CIW -29.09- 5.09), intraoperative bleeding volume (MD-137.2695 CI: 55.01 / 219.52), and gender, age, Child-Pugh grade of liver function, diabetes mellitus, spleen mass. Platelet, prothrombin time and portal vein velocity were not significant at 1 week after operation. Conclusion the risk factors of portal vein thrombosis after devascularization in patients with cirrhosis and portal hypertension are the enlargement of portal vein diameter, the decrease of portal vein velocity, the low platelet count before operation, and the amount of intraoperative bleeding. There was no direct correlation between the onset and sex, age, Child-Pugh grade of liver function, diabetes mellitus, spleen mass, platelet count 1 week after operation, prothrombin time and portal vein velocity before operation.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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