肝硬化门静脉高压症患者脾切除术后腹腔内脏血管直径变化分析

Analysis on splanchnic vessel diameter changes following splenectomy in cirrhotic portal hypertension

目的探讨肝硬化门静脉高压症患者脾切除术后腹腔内脏血管直径变化。方法采用回顾性队列研究方法。收集2012年1月至2022年6月宁夏回族自治区人民医院收治的149例肝硬化门静脉高压症行脾切除术患者的临床资料;男115例,女34例;年龄为46(17~68)岁。患者术前,术后1周、2周、1个月、3个月、6个月、1年、3年、5年行腹部CT检查,图像三维重建后测量门静脉系统和腹腔内脏动脉系统血管直径。偏态分布的计量资料以M(范围)表示。重复测量数据采用广义线性混合模型分析,估算目标的边际均值以均数±标准误表示。分析术后不同时间点血管直径与术前直径差异采用简单效应,边际均值的多重比较采用连续Bonferroni校正。结果(1)脾切除术前后肝总动脉、肝固有动脉和胃十二指肠动脉直径变化。患者脾切除术前后肝总动脉、肝固有动脉、胃十二指肠动脉直径变化趋势比较,差异均有统计学意义(F=28.66,29.46,8.12,P<0.05)。患者脾切除术后1周、2周、1个月、3个月、6个月、1年、3年、5年肝总动脉直径均较术前增粗(P<0.05),术后1周达到峰值,此后缓慢下降并波动。脾切除术后1周、2周、1个月、3个月、6个月、1年、3年、5年肝固有动脉和胃十二指肠动脉直径均较术前增粗(P<0.05),均于术后1个月达到峰值,此后缓慢下降并波动。(2)脾切除术前后脾动脉、腹腔干和胃左动脉直径变化。患者脾切除术前后脾动脉、腹腔干直径变化趋势比较,差异均有统计学意义(F=155.33,66.40,P<0.05)。脾切除术后1周、2周、1个月、3个月、6个月、1年、3年、5年脾动脉、腹腔干直径均较术前变细(P<0.05),术后3个月内变化明显,其后趋于平稳。患者脾切除术前后胃左动脉直径变化趋势比较,差异无统计学意义(F=1.07,P>0.05)。(3)脾切除术前后肠系膜上动脉、右肾动脉和左肾动脉直径变化。患者脾切除术前后肠系膜上动脉、右肾动脉、左肾动脉直径变化趋势比较,差异均有统计学意义(F=8.22,13.21,10.27,P<0.05)。脾切除术后1、3、6个月,1、3年肠系膜上动脉直径均较术前增粗(P<0.05)。脾切除术后1周、2周、1个月、3个月、6个月、1年、3年、5年右肾动脉和左肾动脉直径均较术前增粗(P<0.05)。(4)脾切除术前后门静脉、肠系膜上静脉直径变化。门静脉、肠系膜上静脉变化趋势比较,差异均有统计学意义(F=31.74,2.01,P<0.05)。患者脾切除术后1周、2周、1个月、3个月、6个月、1年、3年、5年门静脉直径均较术前变细(P<0.05),肠系膜上静脉直径分别与术前比较,差异均无统计学意义(P>0.05)。结论肝硬化门静脉高压症患者脾切除术后门静脉、脾动脉及腹腔干直径变细,肝总动脉、肝固有动脉、胃十二指肠动脉、肠系膜上动脉及肾动脉直径增粗,该血管直径变化持续达5年。

Objective To investigate the splanchnic vessel diameter changes following splenectomy in cirrhotic portal hypertension.Methods The retrospective cohort study was conducted.The clinical data of 149 patients with cirrhotic portal hypertension who underwent splenectomy in the People′s Hospital of Ningxia Hui Autonomous Region from January 2012 to June 2022 were collected.There were 115 males and 34 females,aged 46(range,17−68)years.The patients underwent abdominal computed tomography(CT)before surgery and at 1 week,2 weeks,1 month,3 months,6 months,1 year,3 years,5 years after surgery.The blood vessel diameters in the portal vein system and abdominal visceral artery system were measured after three‐dimensional image reconstruction.Measurement data with skewed distribution were represented as M(range).The repeated measured data were analyzed using the generalized linear mixed model,and the marginal mean of the estimated target was expressed as Mean±SE.Simple effects were used to analyze the differences in vascular diameter between pre‐surgery and different time points after surgery,and sequential Bonferroni adjusted significance was used for multiple comparisons of marginal means.Results(1)Changes in diameters of common hepatic artery(CHA),proper hepatic artery(PHA),gastroduodenal artery(GDA)before and after splenectomy.There were significant differences in the diameter change of CHA,PHA and GDA before and after splenectomy(F=28.66,29.46,8.12,P<0.05).The diameter of CHA was thicker at 1 week,2 weeks,1 month,3 months,6 months,1 year,3 years,and 5 years after splenectomy than pre-surgery(P<0.05).It reached a peak at 1 week after surgery,and then declined slowly and fluctuated.The diameters of PHA and GDA were thicker at 1 week,2 weeks,1 month,3 months,6 months,1 year,3 years,and 5 years after splenectomy(P<0.05).They reached a peak at 1 month after surgery,and then declined slowly and fluctuated.(2)Changes in diameters of splenic artery(SA),celiac artery(CA),and left gastric artery(LGA)before and after splenectomy.There were significant differences in the diameter change of SA and CA before and after splenectomy(F=155.33,66.40,P<0.05).The diameters of SA and CA at 1 week,2 weeks,1 month,3 months,6 months,1 year,3 years,and 5 years after splenectomy were thinner than those before operation(P<0.05),the changes of which were obvious within 3 months after splenectomy,and then tended to be stable.There was no significant difference in the diameter of the LGA before and after splenectomy(F=1.07,P>0.05).(3)Changes in diameters of superior mesenteric artery(SMA),right renal artery(RRA),left renal artery(LRA)before and after splenectomy.There were significant differences in the diameter change of SMA,RRA and LRA before and after splenectomy(F=8.22,13.21,10.27,P<0.05).The diameter of SMA at 1 month,3 months,6 months,1 year,and 3 years after splenectomy was thicker than those before operation(P<0.05).The diameters of both RRA and LRA were thicker at 1 week,2 weeks,1 month,3 months,6 months,1 year,3 years,and 5 years after splenectomy than those before operation(P<0.05).(4)Changes in diameters of portal vein(PV)and superior mesenteric vein(SMV)before and after splenectomy.There were significant differences in the diameter change of PV and SMV before and after splenectomy(F=31.74,2.01,P<0.05).The diameter of PV at 1 week,2 weeks,1 month,3 months,6 months,1 year,3 years,and 5 years after splenectomy was thinner than that before operation(P<0.05),and there was no significant difference in the diameter of SMV at above time points compared with that before operation(P>0.05).Conclusions After splenectomy in patients with cirrhotic portal hypertension,the diameters of PV,SA and CA were reduced,and the diameters of CHA,PHA,GDA and renal artery,superior mesenteric artery were enlarged.These postoperative vessel diameter changes maintain as long as five years.