Postoperative complications of laparoscopic splenectomy in patients with portal hypertension
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摘要:
目的探讨门静脉高压症患者行腹腔镜脾切除术后并发症的发生率及影响因素。方法回顾性分析2009年6月-2014年12月湖北医药学院附属十堰市人民医院收治的83例行腹腔镜脾切除术的门静脉高压症患者的临床资料,采用Clavien-Dindo分级系统统计术后并发症的发生率,采用χ2检验和Logistic回归法分析其发生的相关危险因素。结果术后并发症的发生率为24.10%(20/83),依据Clavien-Dindo分级系统,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级并发症分别有5、3、10、2、0例。行全腹腔镜脾切除术患者术后并发症的发生率高于行手助式腹腔镜脾切除术患者,差异有统计学意义(32.59%vs 15.00%,χ2=3.966,P=0.046)。单因素分析显示Child-Pugh分级、是否使用手助器、是否行食管胃底静脉结扎术及ASA分级与术后并发症的发生有关(P值均<0.05)。进一步多因素分析结果显示,Child-Pugh B级和ASAⅢ级均是术后发生并发症的独立危险因素[比值比(OR)=0.328,95%可信区间(95%CI):0.1290.834,P=0.023;OR=0....
Abstract:Objective To investigate the incidence rate and risk factors for the complications after laparoscopic splenectomy in patients with portal hypertension. Methods The clinical data of 83 patients with portal hypertension,who were admitted to our hospital and underwent laparoscopic splenectomy from June 2009 to December 2014,were analyzed retrospectively. The incidence rate of the complications was analyzed using the Clavien-Dindo classification system and the risk factors for the complications were analyzed using chi-square test and logistic regression method. Results The incidence rate of postoperative complications was 24. 10%( 20 /83). According to the Clavien-Dindo classification system,the numbers of patients with grade Ⅰ,Ⅱ,Ⅲ,Ⅳ,and Ⅴ complications were 5,3,10,2,and 0,respectively. The patients undergoing total laparoscopic splenectomy had a significantly higher incidence rate of postoperative complications than those undergoing hand-assisted laparoscopic splenectomy( 32. 59% vs 15. 00%,χ2= 3. 966,P = 0. 046). According to the univariate analysis,the Child-Pugh class,application of the hand-assisted device,gastroesophageal vein ligation,and American Society of Anesthesiologists( ASA) grade were all risks factors for the postoperative complications( all P < 0. 05). Further analysis using multiple logistic regression illustrated that Child-Pugh class B and ASA grade Ⅲ were independent risk factors for the postoperative complications( OR = 0. 328,95% CI: 0. 129 ~ 0. 834,P < 0. 05; OR = 0. 294,95% CI: 0. 150 ~ 0. 573,P < 0. 05). Conclusion Patients with portal hypertension undergoing laparoscopic splenectomy have a high incidence of postoperative complications and the occurrence of the complications is closely associated with the Child-Pugh class and the ASA grade.
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Key words:
- hypertension,portal /
- laparoscopy /
- splenectomy /
- postoperative complications
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