超声预测肝硬化脾切除联合脾肾静脉分流术后吻合口闭塞的初步研究

目的：利用超声技术预测肝硬化脾切除联合脾肾静脉分流术后吻合口闭塞。方法：回顾性分析肝硬化门静脉高压行脾切除联合脾肾静脉分流术患者53例，依据门静脉系统CT对脾肾静脉吻合口通畅性的检查结果，将患者分为通畅组39例和闭塞组14例。比较两组门静脉和脾静脉内径、血流速度及血流量、血栓形成情况、血流方向等超声指标，分析预测脾肾静脉吻合口闭塞的影响因素。结果：与通畅组比较，闭塞组门静脉内径增宽，脾静脉内径变窄、血栓形成、血流速度降低、血流量减少、血流呈向肝性改变，差异有统计学意义(均P<0.05)。结论：门静脉内径增宽，脾静脉内径变窄、血栓形成、血流速度降低、血流量减少、血流呈向肝性改变等超声指标是预测肝硬化脾切除联合脾肾静脉分流术后脾肾静脉吻合口闭塞的影响因素。

A preliminary study on predicting anastomotic occlusion in patients with cirrhosis underwent splenectomy combined with splenorenal shunt by ultrasonography

Objective: To predict anastomotic occlusion aft er splenectomy combined with splenorenal shunt surgery by ultrasound technique.Methods: To retrospectively analyze 53 cases of splenectomy combined with splenorenal shunt surgery. We divided these patients into 2 groups: a patency group (n=39) and an occlusion group (n=14), which were based on the results of splenorenal venous anastomotic stoma with spiral CT. Th e statistical methods were used to analyze the ultrasound detection indicators (the internaldiameter, blood flow velocity, blood flow volume, thrombosis and blood flow direction of portalvein, splenic vein, and superior mesenteric vein) for those 2 groups, and then to figure out thepredictive factors that affect splenorenal venous anastomotic stoma.Results: Compared with the patency group, there are significant broadening of the portal veindiameter, narrowing of the splenic vein diameter, reduction of the splenic vein blood flow velocity,reduction of splenic venous flow volume, splenic vein thrombosis formation and changes of thesplenic vein blood flow direction (all P<0.05).Conclusion: Ultrasound indicators of portal vein diameter broadening, splenic vein diameternarrowing, splenic vein blood flow velocity reduction, splenic venous flow volume reduction,splenic vein thrombosis formation and change of splenic vein blood flow direction are influentialfactors for the splenorenal anastomotic occlusion in patients after splenectomy combined withsplenorenal shunt surgery.