Singh Irom Keshorjit, Bhatnagar V, Gupta A K, Seith A
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
Pediatr Surg Int. 2011 May;27(5):467-71. doi: 10.1007/s00383-010-2847-3.
To study the correlation between the volume of the spleen and hematological parameters, splenic vein diameter, portal pressure before shunt, portal pressure after shunt, reduction of portal pressure and grade of esophageal varices in patients with extrahepatic portal vein obstruction (EHPVO).
Twenty-four patients with EHPVO who underwent splenectomy with leino-renal shunt during a period of 2 years were prospectively analyzed. Splenic volumes were measured from CT scans using appropriate volumetry software. In order to standardize the difference in the size of the patients, the splenic volume was expressed as a ratio, the splenic volume index, between the actual volume as measured on the CT scan and the surface area of the body. The splenic vein diameter was measured on the CT portogram and confirmed during surgery using a caliper. The grade of esophageal varices was determined during esophageal endoscopy using the Japanese Research Society for Portal Hypertension classification. The portal pressure was measured by cannulating a venous tributary of the gastro-epiploic arcade and using a pressure transducer.
The splenic volume, expressed as splenic volume index, ranged from 362.15 to 1,849.51 ml/m² (mean 929.23 ± 409.02). Larger splenic volumes were associated with lower hemoglobin and platelet counts and significantly lower total leukocyte counts (p = 0.0003). The portal pressures reduced remarkably following the splenectomy and leino-renal shunt; mean post-shunt pressure 20 ± 6.63 mmHg from mean pre-shunt pressure of 34.33 ± 6.21 mmHg (mean percentage reduction 43.37 ± 16.02%). There was no statistically significant correlation between splenic volume and any of the hemodynamic parameters except a weak correlation with splenic vein diameter. There was no correlation between the splenic vein diameter and the pre-shunt portal pressure; however, there was a statistically significant correlation between the splenic vein diameter and the percentage of post-shunt portal pressure reduction (p = 0.0494).
Splenic volume has a weak correlation with splenic vein diameter, but does not correlate with portal pressure or the grade of varix. Splenic vein diameter has a statistically significant correlation with the percentage of portal pressure reduction following a leino-renal shunt. There is a statistically significant negative correlation between the splenic volume and the total leukocyte count.
研究肝外门静脉阻塞（EHPVO）患者的脾脏体积与血液学参数、脾静脉直径、分流术前门静脉压力、分流术后门静脉压力、门静脉压力降低程度以及食管静脉曲张分级之间的相关性。
对24例在2年期间接受脾肾分流脾切除术的EHPVO患者进行前瞻性分析。使用合适的容积测量软件从CT扫描测量脾脏体积。为了标准化患者体型差异，脾脏体积表示为CT扫描测量的实际体积与体表面积之比，即脾脏体积指数。在CT门静脉造影上测量脾静脉直径，并在手术中使用卡尺进行确认。使用日本门静脉高压研究学会的分类法在食管内镜检查期间确定食管静脉曲张的分级。通过插入胃网膜弓的静脉分支并使用压力传感器测量门静脉压力。
以脾脏体积指数表示的脾脏体积范围为362.15至1849.51 ml/m²（平均929.23±409.02）。脾脏体积越大，血红蛋白和血小板计数越低，总白细胞计数显著越低（p = 0.0003）。脾切除和脾肾分流术后门静脉压力显著降低；分流术后平均压力为20±6.63 mmHg，分流术前平均压力为34.33±6.21 mmHg（平均降低百分比为43.37±16.02%）。除了与脾静脉直径有弱相关性外，脾脏体积与任何血流动力学参数之间均无统计学显著相关性。脾静脉直径与分流前门静脉压力之间无相关性；然而，脾静脉直径与分流后门静脉压力降低百分比之间存在统计学显著相关性（p = 0.0494）。
脾脏体积与脾静脉直径有弱相关性，但与门静脉压力或静脉曲张分级无关。脾静脉直径与脾肾分流术后门静脉压力降低百分比有统计学显著相关性。脾脏体积与总白细胞计数之间存在统计学显著负相关。
