| 胡雄伟,丁同领,洪智贤,雷光林,刁广浩.脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析[J].,2018,(22):4256-4260 |
| 脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析 |
| Influence of Splenectomy and Pericardial Devascularization on Hepatic Hemodynamics in Patients with Cirrhosis and Portal Hypertension and Factors Related to Postoperative Portal Vein Thrombosis |
| 投稿时间：2018-04-27 修订日期：2018-05-21 |
| DOI：10.13241/j.cnki.pmb.2018.22.012 |
| 中文关键词: 肝硬化门静脉高压 脾切除及贲门周围血管离断术 肝脏血流动力学 门静脉血栓 危险因素 |
| 英文关键词: Cirrhosis and portal hypertension Splenectomy and pericardial vascular disconnection Liver hemodynamics Portal vein thrombosis Risk factors |
| 基金项目:北京市科技计划基金项目（Z131438） |
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| 中文摘要: |
| 摘要 目的：探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响，并分析患者术后门静脉血栓形成的危险因素。方法：选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者，于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率，并将患者分为血栓组（n=28）和无血栓组（n=68），对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析，并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果：患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势，肝动脉内径、最大流速、血流量呈逐渐升高的趋势，且各时间点间两两比较差异有统计学意义（P<0.05）。术后7d内有28例患者出现门静脉血栓，发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义 （P>0.05）；血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组，术后门静脉内径、术后门静脉流速均低于无血栓组（P<0.05）。经Logistic多因素回归分析显示，患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素（P<0.05）。结论：行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测，有助于患者术后的疗效判断，且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the influence of splenectomy and pericardial devascularization on hepatic hemodynamics in patients with cirrhosis and portal hypertension, the risk factors of postoperative portal vein thrombosis were analyzed. Methods: 96 patients with cirrhosis and portal hypertension who underwent splenectomy and pericardial devascularization in our hospital from January 2016 to December 2017 were selected. The hemodynamic indexes of the liver were dynamically monitored by color Doppler ultrasound before operation and 1d, 3d and 7d after operation. The incidence of portal vein thrombosis 7d after operation was statistically analyzed, the patients were divided into thrombus group (n=28) and non thrombus group (n=68), single factor analysis of the general data, operative indicators, color Doppler ultrasound monitoring indicators and so on were made, multivariate Logistic regression analysis was used to analyze the risk factors of portal vein thrombosis. Results: The diameter, maximum velocity and blood flow of portal vein were decreasing gradually, the diameter, maximum velocity and blood flow of hepatic artery increased gradually before and 1d, 3d and 7d after operation, the differences between each time point were statistically significant (P<0.05). There were 28 cases of portal vein thrombosis at 7d after operation, the incidence was 29.17%. There were no significant difference in gender, age, body mass index, operative time and portal vein flow velocity between thrombus group and non thrombus group (P>0.05). The Child-Pugh classification of patients with thrombus group was B grade, intraoperative bleeding, spleen mass, ascites volume, and anterior portal vein diameter were higher than those of non thrombus group. The internal diameter of portal vein and the velocity of portal vein after operation in the thrombus group were all lower than those of the non thrombus group (P<0.05). Multivariate Logistic regression analysis showed that postoperative portal vein diameter and postoperative portal vein flow velocity were risk factors of portal vein thrombosis (P<0.05). Conclusion: Hepatic hemodynamics was monitored after splenectomy and pericardial devascularization in cirrhotic patients with portal hypertension is helpful to judge the curative effect of postoperative patients.Postoperative portal vein diameter and postoperative portal vein flow rate are risk factors of portal vein thrombosis. |
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