脾切除术与TIPS术治疗肝硬化患者门静脉血栓发生率比较  

Comparison of incidence of portal vein thrombosis in cirrhotics with hypersplenism after undergoing splenectomy or TIPS

作　　者：李婷[1] 毛小荣[2] 张雪梅 李俊峰[2] Li Ting;Mao Xiaorong;Zhang Xuemei(Department of Infectious Dseases,Second Affiliated Hospital,Jiaotong University,Xi’an 710004,Shaanxi Province,China)

机构地区：[1]西安交通大学第二附属医院感染病科,西安市710004 [2]兰州大学第一医院感染病科

出　　处：《实用肝脏病杂志》2022年第5期685-688,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金资助项目(编号:81800528);甘肃省自然科学基金资助项目(编号:20JR5RA364);甘肃省重点研发计划项目(编号:20YF2FA011);甘肃省感染肝病临床医学研究中心研究项目(编号:21JR7RA392);兰州大学第一医院院长基金资助项目(编号:ldyyyn2020-02/ldyyyn2020-14)。

摘　　要：目的比较脾切除术与经颈静脉肝内门腔静脉内支架分流术(TIPS)治疗肝硬化患者门静脉血栓(PVT)发生率的差异。方法2017年1月~2018年12月兰州大学第一医院诊治的肝硬化并发脾功能亢进症患者96例,其中接受脾切除者45例,接受TIPS术治疗者51例。术后随访12个月,使用腹部超声或CT或CTA检查诊断PVT。应用Kaplan-Meier法计算PVT累计发生率。结果在术后1个月、3个月、6个月和12个月,脾切除术组PVT累计发生率分别为40.0%、46.7%、48.9%和48.9%,显著高于TIPS术组(分别为7.8%、9.8%、15.7%和21.6%,P<0.05);在接受脾切除术患者,基线指标比较发现PVT组门静脉主干直径显著大于非PVT组,差异具有统计学意义(P<0.05);在TIPS术后1年,发生PVT患者11例(21.6%)。基线指标比较,未发现发生与未发生PVT组各指标具有统计学差异(P>0.05)。结论在肝硬化并发脾功能亢进症患者,接受脾切除术后PVT累计发生率显著高于TIPS术。因此,术前应认真评估病情,严格掌握适应证,择优选择手术方法,并积极给予防治处理。Objective The purpose of this study was to compare the incidence of portal vein thrombosis(PVT)after splenectomy or transjugular portal systemic shunt(TIPS)in patients with cirrhosis and hypersplenism.Methods 96 patients with cirrhosis and hypersplenism were enrolled and underwent splenectomy(n=45)or TIPS(n=51)in the Second Hospital,Lanzhou University,between January 2017 and December 2018,and all the patients were followed-up for one years.The PVT was diagnosed on ultrasonography,CT or CTA.The cumulative incidences between the two groups were compared by Kaplan-Meier method.Results At 1 month,3 months,6 months and 12 months after operation,the cumulative incidences of PVT in patients receiving splenectomy were 40.0%,46.7%,48.9%and 48.9%,significantly higher than 7.8%,9.8%,15.7%and 21.6%(P<0.05)in patients underwent TIPS;in patients receiving splenectomy,the baseline material analysis showed that the diameter of portal vain in 22 patients with PVT was significantly wider than in 23 patients without(P<0.05);one-year after TIPS,the incidence of PVT was 21.6%,and there were no significant differences as respect to baseline materials between patients with and those without PVT(P>0.05).Conclusion The cumulative incidence of PVT in patients with cirrhosis after splenectomy is relatively higher than that after TIPS.Therefore,the clinicians should carefully evaluate patient's condition before operation,strictly meeting the indications of splenectomy or TIPS,and make the appropriate choice in this setting.

关 键 词：肝硬化 脾切除术 经颈静脉肝内门腔静脉内支架分流术 门静脉血栓 

分 类 号：R657.3[医药卫生—外科学]