肝癌合并脾亢行部分脾栓塞术后急性门脉血栓形成的危险因素分析  

Risk Factors of Acute Portal Vein Thrombosis after Partial Splenic Artery Embolization in Hepatocellular Carcinoma Combined with Hypersplenism Patients

作　　者：谭国胜[1] 罗炳棋[1] 马振江[1] 杨建勇[1] 庄文权[1] 陈伟[1] 

机构地区：[1]中山大学附属第一医院介入科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2014年第6期914-919,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】回顾性分析原发性肝细胞癌(HCC)合并脾功能亢进的患者行部分脾动脉栓塞(PSE)后发生急性门脉血栓形成的临床危险因素。【方法】采用病例-对照研究,回顾性分析107确诊为HCC合并脾功能亢进并行PSE治疗的患者的临床、实验室检查及影像学资料。将所有患者分为两组:病例组和对照组。PSE术后一个月内出现门脉血栓形成者为病例组;而未出现门脉血栓者则为对照组。应用Logistic回归模型,筛选HCC合并脾亢患者行PSE后发生急性门静脉血栓的危险因素。【结果】107例患者中PSE术后一月内出现急性门脉血栓形成者共13例,未发现急性门脉血栓者共94例。PSE术中栓塞面积、术后一周的血小板计数及术前CT增强灌注扫描指数中的肝动脉灌注指数为PSE后易发生急性门脉血栓的相关因素。而术中栓塞面积及肝动脉灌注指数则为PSE后发生急性门脉血栓的危险因素;术后一周的血小板计数对判断是否会出现急性门脉血栓有重要的提示意义。【结论】HCC合并脾功能亢进患者行PSE治疗前需了解肝脏血流动力学情况,术中须严格控制脾脏栓塞面积,术后需密切注意血小板计数的变化,以期减少急性门脉血栓形成的可能。[Objective] To identify the risk factors associated with acute portal vein thrombosis （PVT） after partial splenic artery embolization （PSE） in hepatocellular carcinoma （HCC） patients with hypersplenism. [Methods] Retrospectively investigate the clinical, laboratory and imaging data of 107 HCC patients with hypersplenism who underwent partial splenic artery embolization. All patients were divided into two groups according to the appearance of the portal vein thrombosis in the first mouth after the PSE. The logistic regression analysis was applied to identify the risk factors associated with acute PVT after PSE. [Results] Of 107 cases 13 patients had acute portal vein thrombosis within one month after PSE, but 94 patients did not. Embolization area, platelet count, and hepatic artery perfusion index （HPI） in CT perfusion scan were considered to be correlated to acute PVT after PSE in HCC and hypersplenism patients. Embolization area and HPI were supposed to be the risk factors associated with PVT. [Conclusion] Embolization area, platelet count one week after PSE, and HPI of CT perfusion scan are important indexes to predict the appearance of PVT in HCC and hypersplenism patients after PSE.

关 键 词：肝细胞癌 脾功能亢进 部分脾栓塞术 门静脉血栓形成 

分 类 号：R73[医药卫生—肿瘤]