肝豆状核变性肝硬化患者脾切除术后门静脉血栓形成危险因素分析

Influencing factors of portal vein thrombosis after splenectomy in cirrhotic patients with Wilson's disease

目的分析肝豆状核变性肝硬化患者脾切除术后门静脉血栓(PVT)形成的危险因素。方法回顾性分析安徽中医药大学第--附属医院2016年5月至2019年5月因肝豆肝硬化门静脉高压行脾切除术患者70例,按照术后彩超复查是否存在门静脉血栓,分为PVT组38例和非PVT组32例,对比两组临床资料,利用多因素Logistie回归分析法寻找脾切除术后PVT形成的危险因素。结果70例患者中有38例出现PVT,发生率约为54%;PVT组术前门静脉直径(14.74±1.66)mm,明显宽于非PVT组的(11.52±1.78)mm,差异有统计学意义(P<0.05);PVT组术后门静脉流速(13.40±2.11)cm/s,低于非PVT组的(17.50±1.37)cm/s,差异有统计学意义(P<0.05);PVT组术前术后门静脉流速差(5.32±1.88)cm/s,明显高于非PVT组的(1.87±0.95)cm/s,差异有统计学意义(P<0.05)。数据表明,术后PTV的形成的高危因素为直径较宽的门静脉,较低的术后门静脉血流速度,以及较高的门静脉流速差。结论肝硬化脾切除术后PVT形成与门静脉直径、术后门静脉流速及术前术后门静脉流速差等因素有关,可以通过这些指标观察来预测术后PVT的形成。

Objective To investigate the infuencing factors of portal vein thrombosis(PVT)afer splenectomy in eirhotie pa-tients with Wilson's disease.Methods A rero-spective study was performed on 70 cases of liver cirhosis and portal hyperension caused by Wilson's disease undergoing splenectomy-from May 2016 to May 2019 in our hospital.There were 38 cases of PVT,and 32 cases of non-PVT.The perioperative data of PVT group and non-PVT group were compared by Multivariate Logistic regression analysis to analyze the risk factors of portal vein thrombosis after splenectomy.Results Thirty-eight cases developed PVT after splenectomy with the incidence of54%(38/70).The portal vein diameter in the PVT group was(14.74±1.66)mm,which was significantly wi-der than in non-PVT group(11.52±1.78)mm(P<0.05).Postoperation blood flow velocity of portal vein in the PVT group was(13.40±2.11)cm/s,which was significanly slower than in non-PVT group(17.50±1.37)cm/s(P<0.05).The dfference of portal low velocity before and after operation in the PVT group was(5.32±1.88)cn/s,which was significanly larger than in non-PVT group(1.87±0.95)cm/s(P<0.05).Conclusions The incidence of PVT after splenectomy in patients with eirhosis may be associated with the diameter of portal vein,postoperaion blood flow velocity of portal vein and the dffrerence of portal flow velocity before and after operation.PVT after splenectomy can be predicted by these indicators.