脾切除术加食管胃周围血管离断术后门静脉血栓形成的术前预测因素。
Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization.
机构信息
Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
出版信息
World J Gastroenterol. 2012 Apr 21;18(15):1834-9. doi: 10.3748/wjg.v18.i15.1834.
AIM
To evaluate the predictive value of preoperative predictors for portal vein thrombosis (PVT) after splenectomy with periesophagogastric devascularization.
METHODS
In this prospective study, 69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010. The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography. The hepatic congestion index and the ratio of velocity and diameter were calculated before operation. The prothrombin time (PT) and platelet (PLT) levels were measured before and after operation. The patients' spleens were weighed postoperatively.
RESULTS
The diameter of portal vein was negatively correlated with the portal vein flow velocity (P < 0.05). Thirty-three cases (47.83%) suffered from postoperative PVT. There was no statistically significant difference in the Child-Pugh score, the spleen weights, the PT, or PLT levels between patients with PVT and without PVT. Receiver operating characteristic curves showed four variables (portal vein flow velocity, the ratio of velocity and diameter, hepatic congestion index and diameter of portal vein) could be used as preoperative predictors of postoperative portal vein thrombosis. The respective values of the area under the curve were 0.865, 0.893, 0.884 and 0.742, and the respective cut-off values (24.45 cm/s, 19.4333/s, 0.1138 cm/s(-1) and 13.5 mm) were of diagnostically efficient, generating sensitivity values of 87.9%, 93.9%, 87.9% and 81.8%, respectively, specificities of 75%, 77.8%, 86.1% and 63.9%, respectively.
CONCLUSION
The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.
目的
评估术前预测因子对乙型肝炎肝硬化相关门静脉高压症行贲门周围血管离断术后门静脉血栓形成（PVT）的预测价值。
方法
本前瞻性研究纳入 2007 年 1 月至 2010 年 8 月在四川大学华西医院行贲门周围血管离断术的 69 例连续乙型肝炎肝硬化门静脉高压症患者。多普勒超声测量门静脉血流速度和门静脉直径。计算术前肝充血指数和速度与直径的比值。测量术前和术后凝血酶原时间（PT）和血小板（PLT）水平。术后测量脾脏重量。
结果
门静脉直径与门静脉血流速度呈负相关（P < 0.05）。33 例（47.83%）术后发生 PVT。PVT 组与无 PVT 组患者的 Child-Pugh 评分、脾脏重量、PT 或 PLT 水平无统计学差异。受试者工作特征曲线显示 4 个变量（门静脉血流速度、速度与直径的比值、肝充血指数和门静脉直径）可作为术后门静脉血栓形成的术前预测因子。曲线下面积分别为 0.865、0.893、0.884 和 0.742，相应的截断值（24.45cm/s、19.4333/s、0.1138cm/s（-1）和 13.5mm）具有诊断效率，灵敏度分别为 87.9%、93.9%、87.9%和 81.8%，特异性分别为 75%、77.8%、86.1%和 63.9%。
结论
在乙型肝炎肝硬化相关门静脉高压症行贲门周围血管离断术后，速度与直径的比值是预测门静脉血栓形成最准确的术前预测因子。
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