肝豆状核变性患者脾切除术后门静脉系统血栓形成的危险因素分析  

Risk factors for portal vein thrombosis after splenectomy in hepatolenticular degeneration patients complicated with hypersplenism

作　　者：李保启[1] 王佳佳[1] 王金萍[1] 伍宏兵[1] Li Baoqi;Wang Jiajia;Wang Jinping;Wu Hongbing(Department of Ultrasound Medicine,the First Affiliated Hospital of Anhui Traditional Chinese Medical University,Anhui 230031,China)

机构地区：[1]安徽中医药大学第一附属医院超声医学科,合肥230031

出　　处：《中华医学超声杂志（电子版）》2022年第8期818-822,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨肝豆状核变性(HLD)患者脾切除术后围手术期门静脉系统血栓(PVST)形成的高危因素。方法回顾性选取安徽中医药大学第一附属医院于2017年11月至2020年6月因HLD继发脾功能亢进行脾切除术治疗的患者60例。根据术后有无PVST形成将患者分为2组。术前行超声检查测量脾脏最大厚度、门静脉内径及最大血流速度;术后第7天超声检查观察胰腺后方脾静脉、门静脉管腔内有无血栓形成。应用多因素Logistic回归分析HLD继发脾功能亢进患者脾切除术后发生PVST的危险因素,并应用ROC曲线分析不同危险因素对PVST的预测价值。结果门静脉内径(P=0.019)、门静脉血流速度(P=0.012)、脾脏体积(P=0.045)是HLD患者脾切除术后发生PVST的危险因素。ROC曲线结果显示,联合门静脉内径、门静脉血流速度、脾脏体积预测PVST的曲线下面积为0.831,高于单一因素的ROC曲线下面积。结论彩色多普勒超声能够发现并监测HLD患者脾切除术后围手术期PVST,可通过检测术前门静脉内径、门静脉血流速度及术中脾脏体积来预测术后PVST的发生风险。Objective To identify the high risk factors of perioperative portal venous thrombosis(PVST)in patients with hepatolenticular degeneration(HLD)after splenectomy.Methods A total of 60 patients with hypersplenism secondary to HLD at the first Affiliated Hospital of Anhui University of Chinese Medicine from November 2017 to June 2020 were selected for splenectomy.They were divided into two groups according to whether PVST was present after splenectomy.The maximum thickness of the spleen,inner diameter of the portal vein,and maximum blood flow velocity were measured and recorded before splenectomy.Blood embolism in the posterior splenic vein and portal vein was observed on the 7th day after the operation.Multivariate logistic regression was used to analyze the risk factors of PVST in patients with HLD secondary hypersplenism after splenectomy,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of different risk factors for PVST.Results The portal vein diameter(P=0.019),portal vein flow velocity(P=0.012),and spleen volume(P=0.045)were identified to be risk factors for portal vein thrombosis after splenectomy.The area under the curve of combined portal vein diameter,portal vein flow velocity,and splenic volume in predicting the incidence of portal vein thrombosis was 0.831.Conclusion Color Doppler ultrasound can detect and monitor PVST during the perioperative period after splenectomy in patients with HLD.Preoperative portal vein diameter,portal vein blood flow velocity,and intraoperative spleen volume are the high risk factors for PVST.

关 键 词：超声检查 多普勒 彩色 肝豆状核变性 脾切除术 门静脉系统血栓 

分 类 号：R742.4[医药卫生—神经病学与精神病学]