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中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (10) : 790 -793. doi: 10.3877/cma.j.issn.1672-6448.2017.10.014

所属专题： 文献；

腹部超声影像学

门静脉高压症患者脾切除术后门静脉血栓形成的超声影像研究及影响因素
陈曦1, 李志艳1,†(), 王彦1, 周艳贤1, 刘阳1, 冯卉1, 冯松1   
  1. 1. 100039　北京，解放军第三〇二医院超声科
  • 收稿日期:2016-05-30 出版日期:2017-10-01
  • 通信作者: 李志艳
  • 基金资助:
    首都特色基金(Z141100002114043)

Studies of ultrasonic imaging on portal vein thrombosis for patients with portal hypertension splenectomy and analysis of its influencing factors

Xi Chen1, Zhiyan Li1,†(), Yan Wang1, Yanxian Zhou1, Yang Liu1, Hui Feng1, Song Feng1   

  1. 1. Department of Ultrasound, the 302 Hospital of Chinese PLA, Beijing 100039, China
  • Received:2016-05-30 Published:2017-10-01
  • Corresponding author: Zhiyan Li
  • About author:
    Corresponding author: Li Zhiyan, Email:
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引用本文：

陈曦, 李志艳, 王彦, 周艳贤, 刘阳, 冯卉, 冯松. 门静脉高压症患者脾切除术后门静脉血栓形成的超声影像研究及影响因素[J]. 中华医学超声杂志（电子版）, 2017, 14(10): 790-793.

Xi Chen, Zhiyan Li, Yan Wang, Yanxian Zhou, Yang Liu, Hui Feng, Song Feng. Studies of ultrasonic imaging on portal vein thrombosis for patients with portal hypertension splenectomy and analysis of its influencing factors[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(10): 790-793.

目的

通过彩色多普勒超声影像探讨肝硬化门静脉高压症患者脾切除术后7 d门静脉血栓形成机制及影响因素。

方法

选取2013年1月至2015年12月因肝硬化门静脉高压在解放军第三〇二医院实施脾切除加贲门周围血管离断术的患者284例。采用彩色多普勒超声记录术前、术后门静脉、脾静脉及肠系膜上静脉血栓形成情况。根据术后是否发生门静脉血栓，将患者分为门静脉血栓组与无门静脉血栓组，采用Logistic回归分析判定影响门静脉血栓形成的因素。

结果

284例患者中术后发生门静脉血栓患者129例，发病率45.42%（129/284）。Logistic回归分析显示，血栓组的脾静脉内径与非血栓组比较，差异有统计学意义（Z=2.034，P<0.05），术后门静脉内径、凝血酶原时间在血栓组中明显高于非血栓组，差异均有统计学意义（Z=2.037、-2.171，P均<0.05），术前血小板计数在血栓组中明显低于非血栓组，差异有统计学意义（Z=-2.146，P<0.05）；性别、术前肝动脉流速、出凝血时间与术后发生门静脉血栓，差异均无统计学意义（P均>0.05）。

结论

彩色多普勒超声技术不仅可以监测脾切除术后门脉系统血栓形成情况，还可以对脾切除后门脉血栓形成的风险因素进行评估。

关键词: 超声检查, 高血压，门静脉, 脾切除术, 血栓形成
Objective

Through the study of color Doppler ultrasound imaging, to explore the mechanism of portal vein thrombosis for patients with liver cirrhotic portal hypertension splenectomy and its influencing factors.

Methods

From January 2013 to December 2013, a total of 284 cases of patients with cirrhosis and portal hypertension plenectomy plus pericardial devascularization in 302 Hospital of PLA were reviewed. Color Doppler ultrasound technique was employed to record the thrombosis of portal vein, splenic vein and superior mesenteric vein before and after the surgical procedure. According to the occurrence of portal vein thrombosis after splenectomy, patients were divided into portal vein thrombosis group and non portal vein thrombosis group; the factors that may affect the formation of portal vein thrombus were analyzed by using Logistic regression.

Results

One hundred and twenty-nine cases of portal vein thrombosis occurred among the 284 patients with splenectomy, the incidence rate was 45.42% (129/284). Logistic regression analysis shows that inner diameters of splenic vein for the group with portal vein thrombosis are significantly different from that of the group without portal vein thrombosis (Z=2.034, P<0.05), postoperative inner diameter of portal vein (Z=2.037, P<0.05), and prothrombin time (Z=-2.171, P<0.05) are significantly higher in the group with portal vein thrombosis, while preoperative platelet count is significantly lower in the group with portal vein thrombosis (Z=-2.146, P<0.05); gender, preoperative hepatic artery flow velocity, and blood coagulation time are also the influencing factors of portal vein thrombosis (all P>0.05).

Conclusion

Color Doppler ultrasound technology can not only monitor, the thrombus formation in portal venous system post splenectomy, it can assess the risk factors of portal vein thrombosis post splenectomy.

Key words: Ultrasonography, Hypertension, portal, Splenectomy, Thrombosis
图5，6 门静脉部分血栓形成后肝动脉及门静脉血流频谱表现。图5为门脉栓塞后肝动脉流速升高；图6为门静脉内测及低速静脉频谱
表1 肝硬化伴门静脉高压患者行脾切除后门静脉血栓形成因素分析表
参数 Estimate Std. Error Z值 P值
截距 -2.484241 15.942526 -0.156 0.8762
年龄 -0.078908 0.099102 -0.796 0.4259
性别 -3.514464 1.861465 -1.888 0.0590
脾厚 -0.037110 0.073649 -0.504 0.6144
脾长 -0.038561 0.037832 -1.019 0.3081
脾静脉内径 0.165351 0.081286 2.034 0.0419
术前门静脉内径 -0.232118 0.380721 -0.610 0.5421
术后门静脉内径 1.424626 0.699505 2.037 0.0417
术前门静脉流速 0.116625 0.130286 0.895 0.3707
术前肝动脉流速 0.035791 0.021359 1.676 0.0938
凝血酶原时间 -2.041899 0.940712 -2.171 0.0300
活动度 -0.003011 0.021562 -0.140 0.8889
D2聚体 0.233389 0.150175 1.554 0.1202
出凝血时间 0.922255 0.549351 1.679 0.0932
术前血小板计数 -0.091137 0.042464 -2.146 0.0319
术后血小板计数 0.005500 0.003992 1.378 0.1683
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