肝硬化后门静脉血栓形成的临床特点研究  

Clinical characteristics of portal vein thrombosis in patients with liver cirrhosis

作　　者：吴勤[1] 楚金东[1] 金波[1] 刘博[1] 吴立兵[1] 熊小青[1] 马雪梅[1] 孟繁平[1] 陈劲频[1] 申力军[1] 王艳玲[1] 韩军[1] 张文辉[1] 李莉[1] 马威[2] 王华明[3] 李志艳[2] 李捍卫[1] 韩晶晶[1] 

机构地区：[1]解放军第三〇二医院肝硬化诊疗中心,北京100039 [2]解放军第三〇二医院医学影像中心,北京100039 [3]解放军第三〇二医院介入科,北京100039

出　　处：《传染病信息》2013年第3期164-167,共4页Infectious Disease Information

基　　金：军队"十二五"课题重点项目(BWS11J075)

摘　　要：目的研究肝硬化(liver cirrhosis,LC)后门静脉血栓(portal vein thrombosis,PVT)形成的临床特点。方法对9678例LC患者进行回顾性分析,采用腹部B超/腹部增强CT及腹部增强MRI检查门脉主干或左右分支,筛选出LC伴PVT形成者(PVT组),同时将LC后无PVT患者纳为对照组,比较2组的Child-Pugh分级、门静脉及脾静脉宽度、脾脏面积及厚度、腹水、上消化道出血、肝性脑病和肝肾综合征等并发症。结果 LC患者中有396例(4.09%)PVT形成。PVT组中LC的病因主要有乙型肝炎、酒精性及丙型肝炎LC,PVT主要分布在门静脉主干、门静脉右支、肠系膜上静脉、门静脉左支和脾静脉。按Child-Pugh进行分级,PVT组与对照组比较,肝损伤较重(P<0.01)。PVT组合并腹水、上消化道出血、肝性脑病及肝肾综合征等并发症的发病率均较对照组高(P<0.01)。PVT组门静脉和脾静脉宽度分别为(1.50±0.23)cm和(1.25±0.34)cm,对照组为(1.38±0.23)cm和(1.06±0.29)cm。PVT组脾脏面积为(97.48±32.90)cm2,脾脏厚度为(6.09±1.21)cm;对照组分别为(81.19±29.10)cm2和(5.26±0.99)cm。PVT组门静脉及脾静脉宽度和脾脏厚度均大于对照组,差异有统计学意义(P<0.05)。PVT组有侧支循环开放的患者占96.21%,对照组为78.25%,2组比较差异有统计学意义(P<0.05)。结论 LC后PVT形成对LC患者的临床转归有重要影响。Objective To investigate the clinical characteristics of portal vein thrombosis （PVT） in patients with liver cirrhosis （LC）. Methods A total of 9678 LC patients were analyzed retrospectively. The LC patients were assigned to a PVT group （with PVT） and a control group （without PYT） by testing the main portal vein and the left and right portal veins using type B ultrasound or enhanced computed tomography and enhanced magnetic resonance imaging. Child-Pugh classification, the widths of portal vein and splenic vein, the size and thickness of spleen and the incidence of complications such as ascites, upper gastrointestinal bleeding, hepatic encephalopathy and hepatorenal syndrome of the two groups were compared. Results Of all the LC patients, 396 （4.09%） were diagnosed with PVT. The main causes of LC in the PVT group were hepatitis B, alcoholic hepatitis and hepatitis C, and the PVT was mainly located in the main portal vein, the right portal vein, the superior mesenteric vein, the left portal vein and the splenic vein. According to Child-Pugh classification, the liver function lesion of the PVT group was more serious than that of the control group （P〈0.01）. The incidence rates of the complications such as ascites, upper gastrointestinal bleeding, hepatic encephalopathy and hepatorenal syndrome in the PVT group were much higher than those in the control group （P〈0.01）. The widths of portal vein and splenic vein in the PVT group were 1.50±0.23 cm and 1.25±0.34 cm, as compared with 1.38±0.23 cm and 1.06±0.29 cm in the control group. The size and thickness of spleen in the PVT group were 97.48±32.90 cm2 and 6.09±1.21 cm, as compared with 81.19±29.10 cm2 and 5.26±0.99 cm in the control group. The widths of portal vein and splenic vein and the thickness of spleen in the PVT group were greater than those in the control group and the differences between them were significant （P〈0.05）. Collateral circulation was found in 96.21% of the patients in the PVT group, and in 78.25% of t

关 键 词：肝硬化 静脉血栓形成 高血压 门静脉 

分 类 号：R575.2[医药卫生—消化系统]