术前CT/MRI检查指标对肝硬化脾切除术后门静脉血栓形成的预测价值

doi:10.3969/j.issn.1672-5069.2019.03.027

摘要/Abstract

摘要： 目的观察术前CT/MRI检查门静脉系统指标预测肝硬化脾切除术后门静脉血栓形成（PVT）的价值。方法 2016年7月~2018年7月我院收治的87例乙型肝炎肝硬化脾切除术后患者接受CT和MRI检查,随访3个月,观察PVT发生率,采用多因素Logistic回归分析肝硬化脾切除术后PVT形成的独立影响因素。结果在随访3个月末,在87例肝硬化脾切除术后患者发现PVT者46例（52.9%）,均为PVT Ⅰ级,门静脉附壁血栓45例（51.7%）,其中伴肠系膜上静脉附壁血栓14例（16.1%）;46例PVT组门静脉直径为（16.7±2.2） mm,显著大于41例非PVT组【（14.8±1.5） mm,P<0.05】,门静脉流速差为（8.4±5.5） cm/s,显著高于非PVT组【（6.1±3.6） cm/s,P<0.05】,脾容积为（1370.8±370.1） cm³,显著大于非PVT组【（1205.2±357.3） cm³,P<0.05】;多因素Logistic回归分析显示,门静脉直径（OR=0.869,95%CI=0.608~1.246）、门静脉流速差（OR=1.185,95%CI=1.079~1.317）和脾容积（OR=3.427,95%CI=2.215~5.302）均是肝硬化脾切除术后PVT形成的独立影响因素（P<0.05）。结论术前CT/MRI检查指标可以预测肝硬化脾切除术后PVT形成,及时处理和预防将改善患者预后。

关键词: 肝硬化, 脾切除术, 门静脉血栓, CT, MRI

Abstract: Objectiv The aim of this study was to investigate the predictive value of preoperative CT/MRI indicators for portal vein thrombosis（PVT） in patients with liver cirrhosis after splenectomy. Methods 87 patients with hepatitis B liver cirrhosis after splenectomy were retrospectively analyzed in our hospital between July 2016 and July 2018,and all patients were followed-up and underwent CT and MRI check-up. Multivariate logistic regression analysis was applied to predict the independent influencing factors of PVT formation after splenectomy. Results At the end of three-month follow-up,46 patients （52.9%） had PVT out of the 87 patients with cirrhosis,belonging to typeⅠPVT,and mural thrombus was found in 45 patients（51.7%）,out of which,14（16.1%） as mural thrombus in superior mesenteric vein;the diameter of portal vain in 46 patients with PVT was（16.7±2.2）mm,significantly wider than 【（14.8±1.5） mm,P<0.05】 in 41 patients without PVT,the difference of portal vein velocity was （8.4±5.5） cm/s, significantly rapider than [（6.1±3.6） cm/s,P<0.05] in non-PVT group and the spleen volume was （1370.8±370.1） cm³,significantly larger than [（1205.2±357.3） cm³,P<0.05] in non-PVT group;multivariate logistic regression analysis showed that the diameter of portal vein（OR=0.869,95%CI=0.608-1.246）,the velocity difference of portal vein（OR=1.185,95%CI=1.079-1.317）,and the spleen volume（OR=3.427,95%CI=2.215-5.302） were the independent influencing factors of PVT formation after splenectomy in patients with cirrhosis （P<0.05）. Conclusion Preoperative CT/MRI diagnostic indexes such as portal vein diameter,portal vein velocity difference and spleen volume are independent influencing factors of PVT formation after splenectomy for liver cirrhosis.

Key words: Liver cirrhosis, Splenectomy, Portal vein thrombosis, CT, MRI

肖科, 潘志华, 涂波, 陈丽. 术前CT/MRI检查指标对肝硬化脾切除术后门静脉血栓形成的预测价值[J]. 实用肝脏病杂志, 2019, 22(3): 417-420.

Xiao Ke, Pan Zhihua, Tu Bo. Predictive value of preoperative CT/MRI indicators for portal vein thrombosis in patients with liver cirrhosis after splenectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 417-420.

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