术前门静脉血流速度在门静脉高压症断流术后血栓形成中的预测价值

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.

Portal vein flow rate used as a early predictor of portal vein thrombosis after periesophagastric devascularization

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.