脾脏体积、脾静脉血流及血细胞计数在门静脉高压症分期中的意义

目的:研究脾脏体积、脾静脉血流以及外周血血细胞计数与不同肝功能分级的相关性,从而揭示他们在门静脉高压症临床分期中的意义。方法:彩色多普勒超声测定40例肝硬化门静脉高压症患者脾脏体积、脾静脉及门静脉血流速度和血管内径,并进行外周血细胞计数和Child分级,研究各项指标之间的相关性和不同肝功能分级之间的差异。结果:脾静脉内径、脾静脉血流速度、门静脉血流速度和外周血WBC计数在Child分级三组问的差异有显著性,而门静脉内径、外周血RBC、PLT计数在三组之间的差异均无显著性。脾静脉内径和脾静脉血流速度呈负相关(r=-0.43),与门静脉流速也呈负相关(r=-0.330)。WBC与脾静脉流速呈正相关(r=0.353),与门静脉血流速度呈正相关(r=0.393)。脾脏体积与HB呈负相关(r=-0.620),与PLT呈负相关(r=-0.8.34)。PLT与HB呈正相关(r=0.583)。结论:Child分级与反映脾功能亢进程度的指标外周血细胞计数无明显相关;门静脉高压症的分期应该参照肝功能和脾功能两方面。

体位变化对肝硬化门脉高压血流动力学的影响

目的:探讨体位变化对肝硬化门脉高压血流动力学的影响。方法:应用彩色多普勒超声(CDFI)对23例肝硬化伴食管静脉曲张破裂出血病人进行卧位和立位门静脉系统血流动力学指标观察。结果:卧位与立位门静脉主干内径变化比较无显著性差异(>0.05),但血流速度和血流量比较具有显著性差异(<0.05),卧位与立位脾静脉内径比较无显著性差异(>0.05),但血流速度和血流量比较具有显著差异性(<0.05)。结论:立位门静脉及脾静脉血流速度和血流量较卧位明显下降,卧位增加了食管静脉曲张破裂出血的机率。

Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization

AIM:To evaluate the predictive value of preoperative predictors for portal vein thrombosis(PVT)after splenectomy with periesophagogastric devascularization.METHODS:In this prospective study,69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010.The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography.The hepatic congestion index and the ratio of velocity and diameter were calculated before operation.The prothrombin time(PT)and platelet(PLT)levels were measured before and after operation.The patients'spleens were weighed postoperatively.RESULTS:The diameter of portal vein was negatively correlated with the portal vein flow velocity(P<0.05).Thirty-three cases(47.83%)suffered from postoperative PVT.There was no statistically significant difference in the Child-Pugh score,the spleen weights,the PT,or PLT levels between patients with PVT and without PVT.Receiver operating characteristic curves showed four variables(portal vein flow velocity,the ratio of velocity and diameter,hepatic congestion index and diameter of portal vein)could be used as preoperative predictors of postoperative portal vein thrombosis.The respective values of the area under the curve were 0.865,0.893,0.884 and 0.742,and the respective cut-off values(24.45 cm/s,19.4333/s,0.1138 cm/s-1 and 13.5 mm) were of diagnostically efficient,generating sensitivity values of 87.9%,93.9%,87.9%and 81.8%,respectively,specificities of 75%,77.8%,86.1%and 63.9%,respectively.CONCLUSION:The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.