摘要
目的探讨超声引导下门静脉穿刺介入治疗肝硬化门静脉系统血栓的临床疗效。方法54例肝硬化门静脉系统血栓患者,均行超声引导下门静脉穿刺介入治疗。观察术后患者门静脉通畅及转归情况,比较手术前后门静脉血栓Yerdel分级、肝门静脉指标、静脉压变化,分析影响患者预后相关因素。结果54例患者术后门静脉完全通畅率70.37%、部分通畅率27.78%,失败率1.85%;术后消化道出血复发率为9.26%,总生存率为88.89%;术后门静脉血栓Yerdel分级情况优于术前,差异有统计学意义(P<0.05)。术后患者门静脉内径(15.14±2.30)mm、脾静脉内径(11.26±0.37)mm、脾脏肋间厚度(47.84±3.96)mm小于术前的(16.10±2.18)、(12.84±0.85)、(52.53±5.75)mm,血流速度(35.75±8.82)cm/s快于术前的(26.59±8.47)cm/s,差异均有统计学意义(P<0.05)。手术前后患者的肝静脉自由压比较,差异无统计学意义(P>0.05);术后肝静脉楔压(10.39±3.11)mm Hg(1 mm Hg=0.133 kPa)、肝静脉压力梯度(8.98±2.03)mm Hg低于术前的(20.08±6.02)、(14.20±2.26)mm Hg,差异有统计学意义(P<0.05)。存活患者的电解质紊乱占比27.08%、Child-Pugh分级C级占比25.00%低于死亡患者的66.67%、83.33%,差异有统计学意义(P<0.05)。存活患者与死亡患者的性别、病程、住院时间及脾切除、肝性脑病、腹水、消化道出血情况比较,差异无统计学意义(P>0.05)。Logistic回归分析显示,Child-Pugh分级C级是患者死亡的影响因素(P<0.05)。结论超声引导下门静脉穿刺介入治疗肝硬化门静脉系统血栓可有效改善门脉血供,提高生存率,Child-Pugh分级C级可提示不良预后。
Objective To discuss the clinical efficacy of ultrasound-guided portal vein puncture in interventional treatment of portal vein thrombosis in cirrhosis.Methods 54 patients with portal vein thrombosis in cirrhosis were treated with ultrasound-guided portal vein puncture intervention.The patients'portal vein patency and regression were observed after the surgery,and the portal vein thrombosis Yerdel classification,hepatic portal vein index and venous pressure changes before and after surgery were compared to analyze the factors related to the patients'prognosis.Results After surgery,the complete patency rate of portal vein in 54 patients was 70.37%,partial patency rate was 27.78%and failure rate was 1.85%;the recurrence rate of gastrointestinal bleeding was 9.26%and the overall survival rate was 88.89%.After surgery,the portal vein thrombosis Yerdel classification was better than that of before surgery,and the difference was statistically significant(P<0.05).After surgery,the portal vein diameter(15.14±2.30)mm,spleen vein diameter(11.26±0.37)mm,and thickness of spleen intercostal space(47.84±3.96)mm were less than(16.10±2.18),(12.84±0.85),and(52.53±5.75)mm before surgery;the blood flow velocity(35.75±8.82)cm/s was faster than(26.59±8.47)cm/s before surgery;the differences were all statistically significant(P<0.05).There was no statistically significant difference in hepatic venous free pressure before and after surgery(P>0.05).After surgery,the wedged hepatic venous pressure(10.39±3.11)mm Hg(1 mm Hg=0.133 kPa)and hepatic venous pressure gradient(8.98±2.03)mm Hg were lower than(20.08±6.02)and(14.20±2.26)mm Hg before surgery,and the differences were all statistically significant(P<0.05).The percentage of electrolyte disorders in surviving patients was 27.08%and the percentage of Child-Pugh grade C was 25.00%,which were lower than 66.67%and 83.33%in death patients,and the differences were all statistically significant(P<0.05).There was no statistically significant difference between surviving patients and death patients in terms of gender,disease duration,hospital stay,splenectomy,hepatic encephalopathy,ascites,and gastrointestinal bleeding(P>0.05).Logistic regression analysis showed that Child-Pugh grade C was an influencing factor for patient death(P<0.05).Conclusion Ultrasound-guided portal vein puncture intervention for portal vein thrombosis in cirrhosis can effectively improve portal blood supply and increase survival,and Child-Pugh grade C can indicate poor prognosis.
作者
徐蓓佳
李洁
刘宝真
李建志
XU Bei-jia;LI Jie;LIU Bao-zhen(Department of Ultrasound,Shandong Provincial Public Health Clinical Center(Jinan Infectious Diseases Hospital),Jinan 250100,China)
出处
《中国实用医药》
2022年第23期40-43,共4页
China Practical Medicine
