乙肝后肝硬化脾亢患者脾动脉改变的DSA初步研究

发布时间：2018-05-20 04:49

本文选题：乙型肝炎 + 肝硬化　；参考：《遵义医学院》2013年硕士论文

【摘要】：目的：通过对乙肝后肝硬化脾功能亢进(hypersplenism,简称脾亢)患者脾动脉与正常脾脏脾动脉数字减影血管造影(Digital subtraction angiography, DSA)表现的对比研究,探讨乙肝后肝硬化脾亢患者脾动脉的DSA征象,为脾亢患者DSA诊断及介入治疗提供参考。方法：1、研究分组：乙肝后肝硬化脾亢组(脾亢组)和正常脾脏组(对照组)。脾亢组：接受部分脾动脉栓塞术(Partial splenic embolization, PSE)治疗的乙肝后肝硬化脾亢患者60例,按照脾脏肿大程度划分,轻度肿大15例,中度24例,重度21例。对照组：因肝脏病变接受介入治疗的正常脾脏患者20例,其中肝血管瘤18例,肝损伤出血2例。 2、两组病例DSA资料的相关数据收集、整理：将脾动脉全程分为脾外段和脾内段两部分,观察脾外段动脉主干的形态及脾内段动脉血管分支、分布及其他情况,测量脾外段脾动脉主干长度、管径、血液分流量及脾内段血管分支密集度。 3、采用SPSS17.0统计软件分析,两组间比较采用t检验,各组间计量资料比较用单因素方差分析,等级资料比较用秩和检验,各计量参数间相关性分析用Pearson积矩相关分析,计算结果PO.05为差异有统计学意义,P0.01为有显著差异。结果：脾亢组脾脏体积测量与入院时血细胞计数,组间比较差异无统计学意义(P0.05)。脾亢组与对照组脾外段脾动脉主干迂曲情况,脾亢组脾外段动脉主干均有不同程度的迂曲,其中重度迂曲15例,而对照组只有1例,两组比较差异有统计学意义(P=0.000),脾动脉主干迂曲程度与脾脏肿大程度密切相关(P=-0.012,r=0.322)。脾外段动脉主干测量指标比较：其中脾外段动脉主干长度及肝动脉管径测量值比较,差异无统计学意义(P值分别是0.592、0.372)；脾外段动脉主干管径、脾肝动脉管径比值及脾动脉血流量测量值比较差异均有统计学意义(P值均为0.000),即脾亢组脾外段动脉主干管径增粗、脾肝动脉管径比值增大及脾动脉血流量增加,且与脾脏肿大程度呈正相关(相关系数r值分别为0.773、0.403、0.918)。脾亢组与对照组脾内段动脉观测值,两组资料脾叶动脉血管管径、血管分支密集度比较,差异有统计学意义(P值分别为0.047、0.041),即脾亢组脾叶动脉管径较对照组增粗,血管分支密集度减低,且分别与脾脏肿大程度呈正相关和负相关(相关系数r分别为0.811、-0.768)。脾亢组脾内段动脉发生动脉瘤样改变8例21处,中度脾大有3例7处,重度脾大有5例14处,轻度脾大组和对照组未发现类似表现。结论：乙肝后肝硬化并发脾亢会加重脾外段脾动脉主干走行迂曲、管径增粗,其增粗、迂曲程度与脾脏体积增大程度密切相关；脾肝动脉管径比值增大,脾动脉血液分流量增多；脾内段脾叶动脉增粗,血管分支密集度减低,可出现脾动脉瘤样改变。
[Abstract]:Objective: to compare the subtraction angiography, DSA) findings of splenic artery and normal splenic artery in patients with hypersplenism (hypersplenism) in posthepatitic cirrhosis, and to explore the DSA features of splenic artery in patients with hypersplenism after liver cirrhosis. To provide reference for the diagnosis and interventional therapy of DSA in patients with hypersplenism. Methods 1. The study was divided into two groups: liver cirrhosis with hypersplenism (group B) and normal group (group B). In the group of hypersplenism, 60 patients with liver cirrhosis and hypersplenism were treated with partial splenic embolization, PSE). According to the degree of splenomegaly, 15 cases were mildly enlarged, 24 cases were moderate and 21 cases were severe. Control group: 20 cases of normal spleen were treated with interventional therapy, including 18 cases of hepatic hemangioma and 2 cases of hepatic injury hemorrhage. 2, data collection of DSA data of the two groups: the splenic artery was divided into two parts: the extrasplenic artery and the inner splenic segment. The shape of the main artery of the extrasplenic segment and the branches, distribution and other conditions of the artery in the inner segment of the spleen were observed. The length of the main splenic artery, the diameter of the splenic artery, the blood flow and the density of the branches of the splenic artery were measured. 3. SPSS17.0 statistical software was used to analyze, t test was used for comparison between two groups, single factor ANOVA was used for comparison of measurement data among groups, rank sum test was used for rank data comparison, and Pearson product moment correlation analysis was used for correlation analysis among measurement parameters. The difference of PO.05 was statistically significant (P0.01). Results: there was no significant difference between the splenic volume measurement and the blood cell count at admission in the hypersplenism group (P 0.05). The main trunk of the splenic artery in the hypersplenism group and the control group had different degrees of detour, including 15 cases of severe detour, and 1 case of the control group. The difference between the two groups was statistically significant (P = 0.000). The degree of twisting of the main trunk of the splenic artery was closely related to the degree of splenomegaly. Comparison of the measurements of the main trunk of the extrasplenic artery: there was no significant difference in the length of the main trunk of the extrasplenic artery and the diameter of the hepatic artery between the two groups (P = 0. 592 卤0. 372), the diameter of the main artery of the extrasplenic segment was 0. 592%, the diameter of the main artery of the extrasplenic segment was 0. 374%. The ratio of diameter of splenic and hepatic artery and the measured value of splenic arterial blood flow were significantly different (P = 0.000), that is, the diameter of main trunk of splenic artery increased, the ratio of diameter of splenic hepatic artery to diameter of splenic hepatic artery increased, and the blood flow of splenic artery increased in hypersplenic group. There was a positive correlation between splenomegaly and splenomegaly (r = 0.773U 0.403, r = 0.918). The blood vessel diameter and branch density of splenic lobe artery in the two groups were significantly higher than that in the control group (P = 0.047 ~ 0.041), that is, the diameter of splenic lobe artery in hyperactivity group was thicker than that in the control group. The blood vessel branch density decreased, and was positively and negatively correlated with splenomegaly (r = 0.811 ~ 0.768). There were 21 aneurysms in 8 cases, 7 cases in moderate splenomegaly and 14 cases in severe splenomegaly in the hypersplenism group. No similar findings were found in the mild splenomegaly group and the control group. Conclusion: cirrhosis of liver complicated with hypersplenism will aggravate the main trunk of splenic artery in extrasplenic segment, increase the diameter of the main splenic artery, and increase the diameter of the splenic artery, and the degree of detour is closely related to the increase of the splenic volume, The splenic artery shunt volume increased, the splenic lobe artery thickened and the blood vessel branching decreased, the splenic artery aneurysm could be found in the splenic artery.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.62

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