断流术后门静脉血栓形成的危险因素的Meta分析

发布时间：2018-08-19 15:31

【摘要】：目的系统评价肝硬化门脉高压症病人行断流术后门静脉系统形成血栓的有关因素,为断流术后避免门静脉系统形成血栓提供指导。方法使用计算机文献检索PubMed、EMBASE、Cochrane图书馆、中国知网、万方数据库、维普、CBM,检索自建库至2016年09月发表的所有关于断流术后门静脉血栓形成危险因素的病例对照研究,分别由2名研究者通过双人独立评审按照排除标准进行文献筛选并提取数据,采用Rev Man 5.3统计软件进行Meta分析。结果共纳入9篇符合标准的病例对照研究,病例数为2105例,其中,门静脉血栓发生676例,发生率为32.11%。Meta分析结果显示,断流术后门静脉血栓形成与病人术后门静脉直径(MD=1.70,95%CI:0.07~3.34)、术后门静脉流速(MD=-4.98,95%CI:-5.62~-4.33)、术前血小板计数(MD=-17.09,95%CI:-29.09~-5.09)、术中出血量(MD=137.26,95%CI:55.01~219.52)有关,而与病人性别、年龄、肝功能Child-Pugh分级、是否合并糖尿病、脾脏质量、术后1周血小板、术后凝血酶原时间、术前门静脉流速无关。结论肝硬化门脉高压症病人行断流术后门静脉血栓形成的危险因素是术后门静脉直径增宽、术后门静脉流速降低、术前较低的血小板计数、术中出血量多等,其发病与病人性别、年龄、肝功能Child-Pugh分级、是否合并糖尿病、脾脏质量、术后1周血小板计数、术后凝血酶原时间、术前门静脉流速无直接相关性。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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