门静脉CT对脾切除联合贲门周围血管离断术后早期门静脉系统血栓形成评价的应用研究

The study of portal vein CT on early portal vein thrombosis after splenectomy combined with cardiac peripheral devascularization

目的 探讨门静脉CT对评价脾切除联合贲门周围血管离断术后早期门静脉系统血栓形成的价值。方法 回顾性分析行脾切除联合贲门周围血管离断术的96例肝硬化门静脉高压症患者,术前1周CT检查均无血栓。观察术后2周内门静脉系统血栓的情况。结果 96例患者中,术后2周内门静脉系统(除脾静脉)血栓形成率为39.6%,脾静脉残端血栓率为100%。门静脉主干血栓面积小于50(Ⅰ型)14例占14.6%;门静脉主干血栓面积大于50(Ⅱ型)14例占14.6%;门静脉主干完全血栓(Ⅲ型)4例占4.2%;肠系膜上静脉血栓(Ⅳ型)6例占6.3%;门静脉右、左支血栓(Ⅴ型)39.6%,其中右支18例约占18.8%,左支20例约占20.8%。结论 采取脾切除联合贲门周围血管离断术后早期脾静脉残端易形成血栓,CT可以准确判断血栓位置、累及范围、各分支血管血栓间的关系。

Objective To evaluate the value of portal vein CT in evaluating early portal vein thrombosis after splenectomy combined with pericardial devascularization.Methods The data of 96 patients with portal hypertension with cirrhosis who underwent splenectomy combined with cardia peripheral vascular devascularization were retrospectively analyzed. None of them had thrombosis by CT examination one week before surgery. The thrombus of portal vein system was observed two weeks after operation.Results Among the 96 patients, the rate of thrombosis in portal vein system(except splenic vein) was 39.6%,the rate of thrombosis in splenic vein stump was 100%,and the area of portal vein main thrombus was less than 50(typeⅠ) in 14 cases(14.6%) within two weeks after operation. Main portal vein thrombosis area > 50(typeⅡ) in 14 cases(14.6%);Complete portal vein thrombosis(type Ⅲ) in 4 cases(4.2%);Superior mesenteric vein thrombosis(type Ⅳ) in 6 cases(6.3%);Thrombosis of right and left portal vein branches(type Ⅴ) was 39.6%,of which 18 cases were from right branch(18.8%) and 20 cases were from left branch(20.8%).Conclusion The stump of splenic vein is easy to form thrombus in the early stage after splenectomy combined with cardia peripheral vascular dissociation. CT can accurately judge the location of thrombus, the range of involvement and the relationship between thrombus of each branch vessel.