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  

Predictive value of preoperative CT/MRI indicators for portal vein thrombosis in patients with liver cirrhosis after splenectomy

作　　者：肖科 潘志华 涂波 陈丽[2] Xiao Ke;Pan Zhihua;Tu Bo(Department of Radiology,Second Affiliated Hospital,Chengdu Medical College,Chengdu 610051,Sichuan Province,China)

机构地区：[1]成都医学院第二附属医院/核工业416医院放射科,成都市610051 [2]成都医学院第一附属医院放射科

出　　处：《实用肝脏病杂志》2019年第3期417-420,共4页Journal of Practical Hepatology

基　　金：四川省卫生与健康委员会科研基金项目(编号:2010100183)

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PVTⅠ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) cm^3,显著大于非PVT组【(1205.2±357.3) cm^3,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。Objective 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) cm^3,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.

关 键 词：肝硬化 脾切除术 门静脉血栓 CT MRI 

分 类 号：R657.34[医药卫生—外科学]