术前CT/MRI检查指标对肝硬化脾切除术后门静脉血栓形成的预测价值
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摘要
目的观察术前CT/MRI检查门静脉系统指标预测肝硬化脾切除术后门静脉血栓形成(PVT)的价值。方法 2016年7月～2018年7月我院收治的87例乙型肝炎肝硬化脾切除术后患者接受CT和MRI检查,随访3个月,观察PVT发生率,采用多因素Logistic回归分析肝硬化脾切除术后PVT形成的独立影响因素。结果在随访3个月末,在87例肝硬化脾切除术后患者发现PVT者46例(52.9%),均为PVTⅠ级,门静脉附壁血栓45例(51.7%),其中伴肠系膜上静脉附壁血栓14例(16.1%);46例PVT组门静脉直径为(16.7±2.2) mm,显著大于41例非PVT组【(14.8±1.5) mm,P<0.05】,门静脉流速差为(8.4±5.5) cm/s,显著高于非PVT组【(6.1±3.6) cm/s,P<0.05】,脾容积为(1370.8±370.1) cm~3,显著大于非PVT组【(1205.2±357.3) cm~3,P<0.05】;多因素Logistic回归分析显示,门静脉直径(OR=0.869,95%CI=0.608～1.246)、门静脉流速差(OR=1.185,95%CI=1.079～1.317)和脾容积(OR=3.427,95%CI=2.215～5.302)均是肝硬化脾切除术后PVT形成的独立影响因素(P<0.05)。结论术前CT/MRI检查指标可以预测肝硬化脾切除术后PVT形成,及时处理和预防将改善患者预后。
Objective The aim of this study was to investigate the predictive value of preoperative CT/MRI indicators for portal vein thrombosis(PVT) in patients with liver cirrhosis after splenectomy. Methods 87 patients with hepatitis B liver cirrhosis after splenectomy were retrospectively analyzed in our hospital between July2016 and July 2018,and all patients were followed-up and underwent CT and MRI check-up. Multivariate logistic regression analysis was applied to predict the independent influencing factors of PVT formation after splenectomy. Results At the end of three-month follow-up,46 patients(52.9%) had PVT out of the 87 patients with cirrhosis,belonging to typeⅠPVT,and mural thrombus was found in 45 patients(51.7%),out of which,14(16.1%)as mural thrombus in superior mesenteric vein;the diameter of portal vain in 46 patients with PVT was(16.7±2.2)mm,significantly wider than 【(14.8±1.5) mm,P<0.05】 in 41 patients without PVT,the difference of portal vein velocity was(8.4±5.5) cm/s,significantly rapider than [(6.1±3.6) cm/s,P<0.05] in non-PVT group and the spleen volume was(1370.8±370.1) cm3,significantly larger than [(1205.2±357.3) cm~3,P<0.05] in non-PVT group;multivariate logistic regression analysis showed that the diameter of portal vein(OR=0.869,95% CI=0.608-1.246),the velocity difference of portal vein(OR =1.185,95% CI =1.079-1.317),and the spleen volume(OR =3.427,95% CI =2.215-5.302) were the independent influencing factors of PVT formation after splenectomy in patients with cirrhosis(P<0.05). Conclusion Preoperative CT/MRI diagnostic indexes such as portal vein diameter,portal vein velocity difference and spleen volume are independent influencing factors of PVT formation after splenectomy for liver cirrhosis.
Objective The aim of this study was to investigate the predictive value of preoperative CT/MRI indicators for portal vein thrombosis(PVT) in patients with liver cirrhosis after splenectomy. Methods 87 patients with hepatitis B liver cirrhosis after splenectomy were retrospectively analyzed in our hospital between July2016 and July 2018,and all patients were followed-up and underwent CT and MRI check-up. Multivariate logistic regression analysis was applied to predict the independent influencing factors of PVT formation after splenectomy. Results At the end of three-month follow-up,46 patients(52.9%) had PVT out of the 87 patients with cirrhosis,belonging to typeⅠPVT,and mural thrombus was found in 45 patients(51.7%),out of which,14(16.1%)as mural thrombus in superior mesenteric vein;the diameter of portal vain in 46 patients with PVT was(16.7±2.2)mm,significantly wider than 【(14.8±1.5) mm,P<0.05】 in 41 patients without PVT,the difference of portal vein velocity was(8.4±5.5) cm/s,significantly rapider than [(6.1±3.6) cm/s,P<0.05] in non-PVT group and the spleen volume was(1370.8±370.1) cm3,significantly larger than [(1205.2±357.3) cm~3,P<0.05] in non-PVT group;multivariate logistic regression analysis showed that the diameter of portal vein(OR=0.869,95% CI=0.608-1.246),the velocity difference of portal vein(OR =1.185,95% CI =1.079-1.317),and the spleen volume(OR =3.427,95% CI =2.215-5.302) were the independent influencing factors of PVT formation after splenectomy in patients with cirrhosis(P<0.05). Conclusion Preoperative CT/MRI diagnostic indexes such as portal vein diameter,portal vein velocity difference and spleen volume are independent influencing factors of PVT formation after splenectomy for liver cirrhosis.
引文
[1]杨凯奇,陈世耀.特发性门静脉高压症预后及其影响因素.实用肝脏病杂志,2018,21(3):332-335.
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[11]Ghabril M,Agarwal S,Lacerda M,et al.Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation:analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients.Transplantation,2016,100(1):126-133.
[12]Stine JG,Argo CK,Pelletier SJ,et al.Liver transplant recipients with portal vein thrombosis receiving an organ from a high-risk donor are at increased risk for graft loss due to hepatic artery thrombosis.Gastroenterology,2016,150(4):S1034-S1035.
[13]Loffredo L,Pastori D,Farcomeni A,et al.Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis:a systematic review and meta-analysis.Gastroenterology,2017,153(2):480-487.
[14]Jiang GQ,Bai DS,Chen P,et al.Predictors of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection:a retrospective cohort study of 75 consecutive patients with 3-months follow-up.Int J Surg,2016,30(4):143-149.
[15]王亮.肝硬化门静脉高压症术后门静脉血栓形成危险因素及干预措施分析.现代中西医结合杂志,2017,26(6):626-628.
[16]Nery F,Chevret S,Condat B,et al.Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis:Results of a longitudinal study.Hepatology,2015,61(2):660-667.
[17]Noronha F C,Seijo S,Plessier A,et al.Natural history and management of esophagogastric varices in chronic noncirrhotic,nontumoral por tal vein thrombosis.Hepatology,2016,64(2):S254-S254.
[18]贺莎莎,范晓棠,石绣江,等.肝硬化门静脉高压症脾切除术后发生门静脉血栓的风险因素及其预测模型的建立.中国普通外科杂志,2016,25(12):1766-1772.
[19]Villagrán R,Smith G,Rodriguez W,et al.Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy:incidence,analysis and follow-up in 1236 consecutive cases.Obes Surg,2016,26(11):2555-2561.
[20]Bouvier A,Gout M,Audia S,et al.Routine screening of splenic or portal vein thrombosis after splenectomy.Rev Med Interne,2017,38(1):3-7.
[2]Nery F,Chevret S,Condat B,et al.Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis:results of a longitudinal study.Hepatology,2015,61(2):660-667.
[3]Stine JG,Shah NL,Argo CK,et al.Increased risk of portal vein thrombosis in patients with cir rhosis due to nonalcoholic steatohepatitis.Liver Transplant,2015,21(8):1016-1021.
[4]Cui SB,Shu RH,Yan SP,et al.Efficacy and safety of anticoagulation therapy with different doses of enoxaparin for portal vein thrombosis in cirrhotic patients with hepatitis B.Eur JGastroen Hepat,2015,27(8):914-919.
[5]于乐成.美国肝脏研究协会成人患者肝硬化腹水处理实践指南2012修订版.肝脏,2013,18(9):629-630.
[6]Chait Y,Condat B,Cazals-Hatem D,et al.Relevance of the criteria commonly used to diagnose myeloproliferative disorder in patients with splanchnic vein thrombosis.Brit J Haematol,2015,129(4):553-560.
[7]Qi X,Li H,Liu X,et al.Novel insights into the development of portal vein thrombosis in cirrhosis patients.Expert Rev Gastroenterol,2015,9(11):1-12.
[8]林国帅,徐琴,赵淑一,等.肝硬化合并门静脉血栓形成的临床特点及其相关危险因素分析.中华肝脏病杂志,2016,24(7):513-517.
[9]Cagin YF,Atayan Y,Erdogan MA,et al.Incidence and clinical presentati on of portal vein thrombosis in cirrhotic patients.Hepatob Pancreat Dis,2016,15(5):499-503.
[10]Fujiyama S,Saitoh S,Kawamura Y,et al.Portal vein thrombosis in liver cirrhosis:incidence,management,and outcome.Bmc Gastroenterol,2017,17(1):112-120.
[11]Ghabril M,Agarwal S,Lacerda M,et al.Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation:analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients.Transplantation,2016,100(1):126-133.
[12]Stine JG,Argo CK,Pelletier SJ,et al.Liver transplant recipients with portal vein thrombosis receiving an organ from a high-risk donor are at increased risk for graft loss due to hepatic artery thrombosis.Gastroenterology,2016,150(4):S1034-S1035.
[13]Loffredo L,Pastori D,Farcomeni A,et al.Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis:a systematic review and meta-analysis.Gastroenterology,2017,153(2):480-487.
[14]Jiang GQ,Bai DS,Chen P,et al.Predictors of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection:a retrospective cohort study of 75 consecutive patients with 3-months follow-up.Int J Surg,2016,30(4):143-149.
[15]王亮.肝硬化门静脉高压症术后门静脉血栓形成危险因素及干预措施分析.现代中西医结合杂志,2017,26(6):626-628.
[16]Nery F,Chevret S,Condat B,et al.Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis:Results of a longitudinal study.Hepatology,2015,61(2):660-667.
[17]Noronha F C,Seijo S,Plessier A,et al.Natural history and management of esophagogastric varices in chronic noncirrhotic,nontumoral por tal vein thrombosis.Hepatology,2016,64(2):S254-S254.
[18]贺莎莎,范晓棠,石绣江,等.肝硬化门静脉高压症脾切除术后发生门静脉血栓的风险因素及其预测模型的建立.中国普通外科杂志,2016,25(12):1766-1772.
[19]Villagrán R,Smith G,Rodriguez W,et al.Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy:incidence,analysis and follow-up in 1236 consecutive cases.Obes Surg,2016,26(11):2555-2561.
[20]Bouvier A,Gout M,Audia S,et al.Routine screening of splenic or portal vein thrombosis after splenectomy.Rev Med Interne,2017,38(1):3-7.