CT扫描评估乙型肝炎肝硬化并发脾功能亢进症患者PSE术后门静脉系统血栓形成价值研究*

doi:10.3969/j.issn.1672-5069.2025.05.027

摘要/Abstract

摘要： 目的使用CT检查确定乙型肝炎肝硬化并发脾功能亢进症患者在接受部分脾动脉栓塞术(PSE)术后门静脉系统血栓形成(PVST)并分析危险因素。方法 2020年1月～2024年6月我院诊治的乙型肝炎肝硬化并发脾功能亢进症患者90例,均接受PSE治疗,使用CT扫描检查随访。应用多因素Logistic回归分析探讨PSE术后PVST发生的危险因素。结果在PSE术后随访3个月时,在90例乙型肝炎肝硬化患者中发生PVST者17例(18.9%);PVST组术后应用低分子右旋糖苷和低分子肝素百分比分别为11.8%和17.6%,显著低于未发生PVST组的37.0%和42.5%(P<0.05);PVST组脾脏最大径、门静脉主干直径、脾静脉直径、肠系膜上静脉直径和脾脏栓塞百分比显著大于,而门静脉血流速率显著慢于未发生PVST组,差异具有统计学意义(P<0.05);多因素Logistic回归分析显示,术后未抗凝、门静脉主干直径>1.58 cm、门静脉血流速率<13.1 cm/s和脾脏栓塞百分比>39.0%是乙型肝炎肝硬化并发脾功能亢进症患者PSE术后发生PVST的独立危险因素(P<0.05)。结论在PSE术后可能发生PVST,及时抗凝和控制栓塞比例可能降低其发生的几率,需要临床进一步验证。

关键词: 肝硬化, 脾功能亢进症, 部分脾动脉栓塞术, 门静脉系统血栓形成, CT扫描

Abstract: Objective The aim of this study was to investigate incidence and risk factors of portal venous system thrombosis(PVST)in patients with hepatitis B-induced liver cirrhosis (LC) and hypersplenism after partial splenic artery embolization (PSE). Methods 90 patients with hepatitis B-induced LC with complicated hypersplenism were encountered in our hospital between January 2020 and June 2024, and all underwent PSE for ameliorating decreased peripheral blood cell counts. Abdominal CT scan was routinely carried out. Multivariate Logistic regression analysis was applied to find impacting factors. Results By three months after PSE, PVST was proven by CT scan in 17 cases (18.9%) out of our 90 patients; percentage of patients with intravenous low molecular dextran and low molecularweight heparin administration after operation in patients with PVST were 11.8% and 17.6%, much lower than 37.0% and 42.5%(P<0.05)in those without PVST; diameter of spleen, diameter of portal vein, diameter of splenic vein, diameter of superior mesenteric vein and percentage of splenic embolism area in patients with PVST were all significantly greater than, while blood flow velocity of portal vein was much slower than in those without PVST (P<0.05); multivariate Logistic regression analysis showed thatno anticoagulant intervention, portal vein diameter >1.58 cm, portal vein blood flowvelocity <13.1cm/s and spleen embolism area percentage >39.0% were all independent risk factors for occurrence of PVST after PSE (P<0.05). Conclusion PVST could occur after PSE in patients with hepatitis B-induced LC and complicated hypersplenism, which might be prevented by in time anticoagulation intervention, and appropriate percentage of splenic embolism area.

Key words: Liver cirrhosis, Hypersplenism, Partial splenic artery embolization, Portal venous system thrombosis, CT scan

王慧芳, 黄世全, 田娟. CT扫描评估乙型肝炎肝硬化并发脾功能亢进症患者PSE术后门静脉系统血栓形成价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 747-750.

Wang Huifang, Huang Shiquan, Tian Juan. CT scan for determination of portal vein system thrombosis in patients with hepatitis B cirrhosis and hypersplenism after partial splenic artery embolization[J]. Journal of Practical Hepatology, 2025, 28(5): 747-750.

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CT扫描评估乙型肝炎肝硬化并发脾功能亢进症患者PSE术后门静脉系统血栓形成价值研究^*

CT scan for determination of portal vein system thrombosis in patients with hepatitis B cirrhosis and hypersplenism after partial splenic artery embolization

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