门静脉高压症患者脾切除术后门静脉血栓形成的超声影像研究及影响因素

Studies of ultrasonic imaging on portal vein thrombosis for patients with portal hypertension splenectomy and analysis of its influencing factors

目的通过彩色多普勒超声影像探讨肝硬化门静脉高压症患者脾切除术后7 d门静脉血栓形成机制及影响因素。方法选取2013年1月至2015年12月因肝硬化门静脉高压在解放军第三〇二医院实施脾切除加贲门周围血管离断术的患者284例。采用彩色多普勒超声记录术前、术后门静脉、脾静脉及肠系膜上静脉血栓形成情况。根据术后是否发生门静脉血栓,将患者分为门静脉血栓组与无门静脉血栓组,采用Logistic回归分析判定影响门静脉血栓形成的因素。结果 284例患者中术后发生门静脉血栓患者129例,发病率45.42%(129/284)。Logistic回归分析显示,血栓组的脾静脉内径与非血栓组比较,差异有统计学意义(Z=2.034,P<0.05),术后门静脉内径、凝血酶原时间在血栓组中明显高于非血栓组,差异均有统计学意义(Z=2.037、-2.171,P均<0.05),术前血小板计数在血栓组中明显低于非血栓组,差异有统计学意义(Z=-2.146,P<0.05);性别、术前肝动脉流速、出凝血时间与术后发生门静脉血栓,差异均无统计学意义(P均>0.05)。结论彩色多普勒超声技术不仅可以监测脾切除术后门脉系统血栓形成情况,还可以对脾切除后门脉血栓形成的风险因素进行评估。

Objective Through the study of color Doppler ultrasound imaging,to explore the mechanism of portal vein thrombosis for patients with liver cirrhotic portal hypertension splenectomy and its influencing factors.Methods From January2013to December2013,a total of284cases of patients with cirrhosis and portal hypertension plenectomy plus pericardial devascularization in302Hospital of PLA were reviewed.Color Doppler ultrasound technique was employed to record the thrombosis of portal vein,splenic vein and superior mesenteric vein before and after the surgical procedure.According to the occurrence of portal vein thrombosis after splenectomy,patients were divided into portal vein thrombosis group and non portal vein thrombosis group;the factors that may affect the formation of portal vein thrombus were analyzed by using Logistic regression.Results One hundred and twenty-nine cases of portal vein thrombosis occurred among the284patients with splenectomy,the incidence rate was45.42%(129/284).Logistic regression analysis shows that inner diameters of splenic vein for the group with portal vein thrombosis are significantly different from that of the group without portal vein thrombosis(Z=2.034,P<0.05),postoperative inner diameter of portal vein(Z=2.037,P<0.05),and prothrombin time(Z=-2.171,P<0.05)are significantly higher in the group with portal vein thrombosis,while preoperative platelet count is significantly lower in the group with portal vein thrombosis(Z=-2.146,P<0.05);gender,preoperative hepatic artery flow velocity,and blood coagulation time are also the influencing factors of portal vein thrombosis(all P>0.05).Conclusion Color Doppler ultrasound technology can not only monitor,the thrombus formation in portal venous system post splenectomy,it can assess the risk factors of portal vein thrombosis post splenectomy.