CT/MRI在预测肝纤维化/肝硬化脾切除术后门静脉血栓形成中的价值
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摘要
目的探讨脾切除术后门静脉血栓(PVT)形成的高危因素,并评价CT/MRI预测PVT形成的价值。方法回顾性分析2005年1月至2016年3月在中山大学附属第三医院因肝纤维化/肝硬化行脾切除术的179例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男148例,女31例;平均年龄(44±12)岁。采用CT/MRI诊断PVT,并测量脾脏体积和门静脉直径。根据术后PVT形成与否将患者分为PVT组(77例)和对照组(102例)。采用单因素分析及多因素Logistic回归分析PVT形成的独立危险因素。根据患者脾脏体积和门静脉直径分布情况确定CT/MRI对PVT形成风险的预测价值。结果多因素Logistic回归分析显示,术前脾脏体积、门静脉直径、PT,手术方式及手术前后Plt差值ΔP7、ΔP14为PVT形成的独立影响因素(OR=4.563,4.443,4.369,3.094,2.117,1.378;P<0.05)。术前脾脏体积≥1 100 cm~3、门静脉直径≥17 mm时脾切除术后PVT形成风险明显增加(χ~2=25.470,16.820;P<0.05)。结论影响单纯性肝纤维化/肝硬化患者脾切除术后PVT形成的因素多且复杂,术前CT/MRI测量脾脏体积及门静脉直径能够为预测PVT形成风险提供重要的参考依据。
Objective To investigate the high risk factors of portal vein thrombosis(PVT) after splenectomy and to evaluate CT/MRI in predicting PVT formation. Methods Clinical data of 179 patients with hepatic fibrosis/cirrhosis who underwent splenectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to March 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 148 males and 31 females with the mean age of(44±12) years old. PVT was diagnosed by CT/MRI and the volume of spleen and the diameter of portal vein were measured. The patients were divided into PVT group(n=77) and control group(n=102) according to the formation of PVT or not after operation. Single factor analysis and multivariate Logistic regression were used to analyze the independent risk factors of PVT formation. The predictive value of CT/MRI for the risk of PVT formation was determined according to the distribution of spleen volume and portal vein diameter of patients. Results Multivariate Logistic regression analysis showed that preoperative spleen volume, portal vein diameter, PT, operative procedure and the D-value of pre-and postoperative Plt ΔP7 and ΔP14 were the independent influencing factors of PVT formation(OR=4.563, 4.443, 4.369, 3.094, 2.117, 1.378; P<0.05). The risk of PVT formation after splenectomy increased significantly when the preoperative spleen volume was≥1 100 cm3 or the portal vein diameter was≥ 17 mm(χ2=25.470, 16.820; P<0.05). Conclusions There are many complicated factors affecting PVT formation after splenectomy in patients with simple hepatic fibrosis/cirrhosis. Preoperative CT/MRI measurement of spleen volume and portal vein diameter can provide important information in predicting the risk of PVT formation.
Objective To investigate the high risk factors of portal vein thrombosis(PVT) after splenectomy and to evaluate CT/MRI in predicting PVT formation. Methods Clinical data of 179 patients with hepatic fibrosis/cirrhosis who underwent splenectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to March 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 148 males and 31 females with the mean age of(44±12) years old. PVT was diagnosed by CT/MRI and the volume of spleen and the diameter of portal vein were measured. The patients were divided into PVT group(n=77) and control group(n=102) according to the formation of PVT or not after operation. Single factor analysis and multivariate Logistic regression were used to analyze the independent risk factors of PVT formation. The predictive value of CT/MRI for the risk of PVT formation was determined according to the distribution of spleen volume and portal vein diameter of patients. Results Multivariate Logistic regression analysis showed that preoperative spleen volume, portal vein diameter, PT, operative procedure and the D-value of pre-and postoperative Plt ΔP7 and ΔP14 were the independent influencing factors of PVT formation(OR=4.563, 4.443, 4.369, 3.094, 2.117, 1.378; P<0.05). The risk of PVT formation after splenectomy increased significantly when the preoperative spleen volume was≥1 100 cm3 or the portal vein diameter was≥ 17 mm(χ2=25.470, 16.820; P<0.05). Conclusions There are many complicated factors affecting PVT formation after splenectomy in patients with simple hepatic fibrosis/cirrhosis. Preoperative CT/MRI measurement of spleen volume and portal vein diameter can provide important information in predicting the risk of PVT formation.
引文
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[15]Raja K,Jacob M,Asthana S.Portal vein thrombosis in cirrhosis[J].J Clin Exp Hepatol,2014,4(4):320-331.
[16]Ponziani FR,Zocco MA,Campanale C,et al.Portal vein thrombosis:insight into physiopathology,diagnosis,and treatment[J].World JGastroenterol,2010,16(2):143-155.
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[18]Alexakis N,Dardamanis D,Albanopoulos K,et al.Incidence,risk factors,and outcome of portal vein thrombosis after laparoscopicassisted splenectomy inβ-thalassemia patients:a prospective exploratory study[J].J Laparoendosc Adv Surg Tech A,2013,23(2):123-128.
[19]Fukui H,Saito H,Ueno Y,et al.Evidence-based clinical practice guidelines for liver cirrhosis 2015[J].J Gastroenterol,2016,51(7):629-650.
[20]徐国森,徐长禄,于波,等.门静脉高压症断流术后门静脉血栓形成的多因素分析[J].世界最新医学信息文摘,2015,15(40):76-77.
[2]Wu S,Wu Z,Zhang X,et al.The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization[J].Turk J Gastroenterol,2015,26(5):423-428.
[3]Li MX,Zhang XF,Liu ZW,et al.Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis[J].Hepatobiliary Pancreat Dis Int,2013,12(5):512-519.
[4]Qi X,Li H,Liu X,et al.Novel insights into the development of portal vein thrombosis in cirrhosis patients[J].Expert Rev Gastroenterol Hepatol,2015,9(11):1421-1432.
[5]Kinjo N,Kawanaka H,Akahoshi T,et al.Portal vein thrombosis in liver cirrhosis[J].World J Hepatol,2014,6(2):64-71.
[6]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[J].Hepatology,2015,61(2):660-667.
[7]Bouvier A,Gout M,Audia S,et al.Routine screening of splenic or portal vein thrombosis after splenectomy[J].Rev Med Interne,2017,38(1):3-7.
[8]汪海洋,陈树军,刘汝斌.晚期肝硬化门静脉高压症脾切除术后发生门静脉血栓的相关因素分析[J].大连医科大学学报,2017,39(2):152-156.
[9]孙琦,蒋佳凯,张盛.对门脉高压患者实施脾切除术后其门静脉系统血栓形成的原因及防治方案探讨[J].当代医药论丛,2017,15(21):94-95.
[10]刘波,姚志成,胡昆鹏.门静脉高压症脾切除术后门静脉血栓发生影响因素分析[J/CD].中华肝脏外科手术学电子杂志,2015,4(5):284-287.
[11]杨勇.肝硬化门静脉高压患者行脾切除断流术后早期门静脉血栓形成的原因分析[J].中国医药指南,2016,14(30):158.
[12]杨培枝.脾切除术后门静脉血栓形成的超声诊断[J].山西医药杂志,2015,44(3):293-294.
[13]Jiang GQ,Bai DS,Chen P,et al.Risk factors for portal vein system thrombosis after laparoscopic splenectomy in cirrhotic patients with hypersplenism[J].J Laparoendosc Adv Surg Tech A,2016,26(6):419-423.
[14]Ahn JH,Yu JS,Cho ES,et al.Diffusion-weighted MRI of malignant versus benign portal vein thrombosis[J].Korean J Radiol,2016,17(4):533-540.
[15]Raja K,Jacob M,Asthana S.Portal vein thrombosis in cirrhosis[J].J Clin Exp Hepatol,2014,4(4):320-331.
[16]Ponziani FR,Zocco MA,Campanale C,et al.Portal vein thrombosis:insight into physiopathology,diagnosis,and treatment[J].World JGastroenterol,2010,16(2):143-155.
[17]Ma J,Yan Z,Luo J,et al.Rational classification of portal vein thrombosis and its clinical significance[J].PLo S One,2014,9(11):e112501.
[18]Alexakis N,Dardamanis D,Albanopoulos K,et al.Incidence,risk factors,and outcome of portal vein thrombosis after laparoscopicassisted splenectomy inβ-thalassemia patients:a prospective exploratory study[J].J Laparoendosc Adv Surg Tech A,2013,23(2):123-128.
[19]Fukui H,Saito H,Ueno Y,et al.Evidence-based clinical practice guidelines for liver cirrhosis 2015[J].J Gastroenterol,2016,51(7):629-650.
[20]徐国森,徐长禄,于波,等.门静脉高压症断流术后门静脉血栓形成的多因素分析[J].世界最新医学信息文摘,2015,15(40):76-77.