CAJ | 학술논문

目的评价术前门静脉血流速度对乙型肝炎肝硬化门静脉高压症断流术后门静脉血栓形成(PVT)中的预测价值.方法对2007年1月至2008年7月在四川大学华西医院同一外科小组行脾切除和断流术的连续45例乙型肝炎后肝硬化门静脉高压症患者,运用彩色多普勒超声测量术前1 d门静脉直径、流速以及术后7 d有无门静脉系统血栓形成.同时计算患者术前Child-Pugh评分.术后测量去脾脏血液后的脾脏重量,检测术前1 d、术后7 d凝血酶原时间(PT)和血小板计数(PLT).并将患者分为血栓组与非血栓组、高速组与低速组,分别对上述指标进行统计学对比分析.结果术后发生门静脉系统血栓13例(28.9%),血栓组(n=13)术前门静脉流速为(19.5±5.3)cm/s,其中12例低于25 cm/s[平均(18.4±3.8)cm/s],1例为32.3 cm/s;非血栓组(n=32)术前门静脉流速为(29.6±8.0)cm/s,两组差异有统计学意义(P<0.01).低速组(n=17)和高速组(n=28)血栓发生率分别为70.6%和3.6%,差异有统计学意义(P<0.01).分别比较两种分组的患者术前Child-Pugh评分、脾脏重量、手术前后PT和PLT,差异均无统计学意义(P>0.05).25 cm/s作为指标预测术后血栓形成的敏感性为92.3%,特异性为70.6%.结论术前门静脉直径增加及血流速度降低是导致术后门静脉系统发生血栓的主要危险因素,尤其当门静脉流速降低(<25 cm/s)时,断流术后血栓发生率将显著增高.门静脉直径与血流速度存在负相关系,可根据门静脉流速预测门静脉高压症断流术后的血栓的形成.
목적 평개술전문정맥혈류속도대을형간염간경화문정맥고압증단류술후문정맥혈전형성(PVT)중적예측개치.방법 대2007년1월지2008년7월재사천대학화서의원동일외과소조행비절제화단류술적련속45례을형간염후간경화문정맥고압증환자,운용채색다보륵초성측량술전1 d문정맥직경、류속이급술후7 d유무문정맥계통혈전형성.동시계산환자술전Child-Pugh평분.술후측량거비장혈액후적비장중량,검측술전1 d、술후7 d응혈매원시간(PT)화혈소판계수(PLT).병장환자분위혈전조여비혈전조、고속조여저속조,분별대상술지표진행통계학대비분석.결과 술후발생문정맥계통혈전13례(28.9%),혈전조(n=13)술전문정맥류속위(19.5±5.3)cm/s,기중12례저우25 cm/s[평균(18.4±3.8)cm/s],1례위32.3 cm/s;비혈전조(n=32)술전문정맥류속위(29.6±8.0)cm/s,량조차이유통계학의의(P<0.01).저속조(n=17)화고속조(n=28)혈전발생솔분별위70.6%화3.6%,차이유통계학의의(P<0.01).분별비교량충분조적환자술전Child-Pugh평분、비장중량、수술전후PT화PLT,차이균무통계학의의(P>0.05).25 cm/s작위지표예측술후혈전형성적민감성위92.3%,특이성위70.6%.결론 술전문정맥직경증가급혈류속도강저시도치술후문정맥계통발생혈전적주요위험인소,우기당문정맥류속강저(<25 cm/s)시,단류술후혈전발생솔장현저증고.문정맥직경여혈류속도존재부상관계,가근거문정맥류속예측문정맥고압증단류술후적혈전적형성.
Objective To evaluate the predictive value of portal vein flow rate preoperative for portal vein thrombosis(PVT)after periesophagastric devascularization in hepatitis B cirrhosis-related portal hypertension. Methods From January 2007 to July 2008,45 patients with portal hypertension caused by hepatitis B cirrhosis were performed splenectomy with periesophagogastric devascularization in the same medical group in West China Hospital of Sichuan University. The portal vein flow rate and the diameter of portal vein were measured with doppler sonography respectively before and after the operation. At the same time,the level of PT and PLT were deteched. The weight of spleens were measured after operation, Results Thirteen cases suffered from PVT postoperatively. Portal vein flow rate was significantly lower in patients with PVT postoperation than that in patients without PVT (P<0.01). In patients with PVT (n=13) postoperation, the preoperation portal vein flow rate was (19.5±5.3) cm/s. Among the 13 cases,there were 12 cases whose flow rate were lower than 25 cm/s, and 1 case whose flow rate was 32.3 cm/s; In patients without PVT ( n=32 ), the preoperation portal vein flow rate was (9.6±8.0) cm/s. In patients with lower rate ( n = 17 ), the incidence rate of PVT was 70. 6% ; in patients with higher rate(n =28), the incidence rate of PVT was 3.6%. The incidence rate of PVT in patients with lower rate was significantly lower than patients with higher rate(P<0.01). The diameter of portal vein in patients with PVT was significantly wider than patients without PVT. The diameter of portal vein was negative correlative with the portal vein flow rate. The value 25 em/s was of diagnostic efficiency,the sensitivity was 92.3% ,and specificity was 70.6%. Conclusions The portal vein flow rate preoperative can be used as an early predictor of portal vein thrombosis after periesophagastric devascularization in hepatitis B cirrhosis-related portal hypertension to give a guide to clinical work.