肝硬化门静脉高压症患者脾切除联合断流术后肝脏体积变化情况分析  

Analysis of the changes in liver volume after splenectomy combined with devascularization for patients with cirrhotic portal hypertension

作　　者：戴志军 田明国[2] 卜阳 李宝定[2] 王立云[2] 杨勇[2] 吴小红 张晓燕 Dai Zhijun;Tian Mingguo;Bu Yang;Li Baoding;Wang Liyun;Yang Yong;Wu Xiaohong;Zhang Xiaoyan(Department of Medical Image Centre,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Hepatobiliary Surgery,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院医学影像中心,银川750002 [2]宁夏回族自治区人民医院肝胆外科,银川750002

出　　处：《中华肝胆外科杂志》2024年第12期893-896,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：宁夏回族自治区重点研发计划(2022BEG02038)。

摘　　要：目的探讨肝硬化门静脉高压症患者脾切除联合断流术后肝脏体积的变化情况,分析相关原因。方法回顾性分析2014年1月至2024年5月在宁夏回族自治区人民医院行脾切除联合断流术的94例肝硬化门静脉高压症患者的临床资料,其中男性61例,女性33例,年龄(47±12)岁。将手术前检测的肝脏体积与手术后的肝脏体积进行比较,依据术后肝脏体积的变化情况分为两组:体积增大组(n=51)和体积减小组(n=43)。收集患者的肝脏体积、肝动脉直径、自发性门体分流(SPSS)情况、门静脉血栓形成(PVT)情况、肝动脉扩张情况等临床资料。结果与体积减小组相比,体积增大组患者的术后肝脏体积[(1157±237)cm^(3)比(977±271)cm^(3)]和肝动脉扩张发生率[92.2%(47/51)比67.4%(29/43)]均增加,而术后新形成的SPSS[3.9%(2/51)比18.6%(8/43)]及PVT[5.9%(3/51)比34.9%(15/43)]的发生率均降低,差异均有统计学意义(均P<0.05)。腹部CT资料显示,脾切除联合断流术后肝脏体积减小患者肝脏边缘锯齿状或波浪状改变加重、肝裂增宽,而肝脏体积增大患者肝脏边缘锯齿状或波浪状改变明显减轻或消失、肝裂变窄。结论脾切除联合断流术可使肝硬化门静脉高压症患者术后肝脏体积增大,术后肝脏体积减小可能与发生SPSS和PVT相关。ObjectiveTo investigate the changes of the liver volume in patients with cirrhotic portal hypertension after splenectomy combined with devascularization,and to analyze the related causes.MethodsClinical and imaging data of 94 patients with cirrhotic portal hypertension who underwent surgical treatment at the People's Hospital of Ningxia Hui Autonomous Region between January 2014 and May 2024 were included and analyzed before and after surgery.The cohort comprised 61 males and 33 females,aged(47±12)years.The preoperative and postoperative liver volumes were compared,and the patients were divided into two groups based on the changes in postoperative liver volume:the volume increase group(n=51)and the volume decrease group(n=43).Clinical data were collected including liver volume,hepatic artery diameter,spontaneous portosystemic shunt(SPSS),portal vein thrombosis(PVT),and hepatic artery dilation.ResultsCompared with the volume decrease group,the postoperative liver volume[(1157±237)cm 3 vs.(977±271)cm 3]and incidence of hepatic artery dilation[92.2%(47/51)vs.67.4%(29/43)]in the volume increase group both increased,while the incidence of newly formed SPSS[3.9%(2/51)vs.18.6%(8/43)]and PVT[5.9%(3/51)vs.34.9%(15/43)]after surgery both decreased,and the differences were statistically significant(all P<0.05).After splenectomy combined with devascularization,patients with decreased liver volume exhibited aggravated conditions of serrated or wavy changes at the edge of the liver and widening of liver fissures,while patients with increased liver volume had significant reduction or disappearance of serrated or wavy changes at the edge of the liver and narrowing of liver fission.ConclusionSplenectomy combined with devascularization can increase the postoperative liver volume in patients with cirrhotic portal hypertension,and decrease in postoperative liver volume may be related to the occurrence of SPSS and PVT.

关 键 词：肝硬化 门静脉高压症 脾切除联合断流术 肝脏体积 门静脉血栓 

分 类 号：R73[医药卫生—肿瘤]