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彩色多普勒超声对原发性肝癌合并门静脉高压的临床诊断效果分析

作者:未知

  [摘要] 目的 探討彩色多普勒超声对原发性肝癌合并门静脉高压的临床诊断效果。 方法 选取2017年3月~2018年3月收治的研究对象为32例原发性肝癌合并门静脉高压患者设为观察组,同期选择32例健康体检人员作为研究对象设为对照组,均选择彩色多普勒超声检查,且观察门静脉主干内径、脾静脉内径、门静脉流量、脾静脉流量、门静脉流速、脾静脉流速及分析门静脉主干内径、脾静脉内径与食管胃底静脉曲张关系。 结果 观察组门静脉主干内径、脾静脉内径、门静脉流量、脾静脉流量均高于对照组,而门静脉流速、脾静脉流速则低于对照组(P<0.05)。门静脉主干内径<1.3 cm患者的食管胃底静脉曲张轻度为9例、中度为3例、重度为0例;门静脉主干内径为1.3~1.4 cm患者的食管胃底静脉曲张轻度为2例、中度为5例、重度为3例;门静脉主干内径>1.4 cm患者的食管胃底静脉曲张轻度为2例、中度为2例、重度为6例;随着门静脉主干内径的增加食管胃底静脉曲张程度越严重。脾静脉内径<0.9 cm患者的食管胃底静脉曲张轻度为9例、中度为2例、重度为0例;门静脉主干内径为0.9~1.0 cm患者的食管胃底静脉曲张轻度为3例、中度为6例、重度为2例;门静脉主干内径>1.0 cm患者的食管胃底静脉曲张轻度为1例、中度为2例、重度为7例;随着脾静脉内径的增加食管胃底静脉曲张程度越严重。 结论 彩色多普勒超声用于原发性肝癌合并门静脉高压中具有较高的临床价值,有利于为疾病诊断及治疗提供客观依据,值得应用及推广。
  [关键词] 彩色多普勒超声;原发性肝癌;门静脉高压;临床诊断
  [中图分类号] R735.7          [文献标识码] B          [文章编号] 1673-9701(2019)11-0133-03
  Diagnostic effect of color Doppler ultrasound on primary hepatic carcinoma with portal hypertension
  SHI Hongwei1   LI Gang1   WANG Shi2   YE Guanxiong2
  1.Department of Ultrasound, Lishui People's Hospital in Zhejiang Province, Lishui   323000, China; 2.Department of General Surgery, Lishui People's Hospital in Zhejiang Province, Lishui   323000, China
  [Abstract] Objective To discuss the diagnostic effect of color Doppler ultrasound on primary hepatic carcinoma with portal hypertension. Methods Thirty-two patients with primary hepatic carcinoma and portal hypertension admitted from March 2017 to March 2018 were enrolled as the observation group. 32 healthy subjects were selected as the control group. Thirty-two patients with primary hepatic carcinoma and portal hypertension admitted from were enrolled as the observation group at the same time. 32 healthy subjects were selected as the control group. All subjects were given color Doppler ultrasonography, and portal vein diameter, splenic vein diameter, portal vein flow, splenic vein flow, portal vein velocity, and splenic vein velocity were observed, and the relationship between portal vein diameter, splenic vein diameter and esophageal and gastric varices were analyzed. Results The portal vein diameter, the splenic vein diameter, the portal vein flow, and the splenic vein flow in the observation group were higher than those in the control group, while the portal vein velocity and splenic vein velocity were lower than in the control group(P<0.05). Among patients with a portal vein diameter of <1.3 cm, 9 patients had mild esophagogastric varices, 3 had moderate, and 0 had severe.In patients with a portal vein diameter of 1.3-1.4 cm, 2 patients had mild esophagogastric varices, 5 had moderate, and 3 had severe. In patients with a portal vein diameter of >1.4 cm, 2 patients had mild esophagogastric varices, 2 had moderate, and 6 had severe. With the increase of the inner diameter of the portal vein, the degree of esophagogastric varices was more serious. In patients with a splenic vein diameter of <0.9 cm, 9 patients had mild esophagogastric varices, 2 had moderate, and 0 had severe. In patients with a splenic vein diameter of 0.9-1.0 cm, 3 patients had mild esophagogastric varices, 6 had moderate, and 2 had severe. In patients with a splenic vein diameter of >1.0 cm, 1 patients had mild esophagogastric varices, 2 had moderate, and 7 had severe. With the increase of the inner diameter of the splenic vein, the degree of esophagogastric varices was more serious. Conclusion Color Doppler ultrasound has high clinical value in primary hepatic carcinoma with portal hypertension, which is helpful for providing an objective basis for disease diagnosis and treatment, and is worthy of application and promotion.   [Key words] Color Doppler ultrasound; Primary liver cancer; Portal hypertension; Clinical diagnosis
  原发性肝癌是临床上较为常见疾病之一,具有较高的发病率,且呈日益上升趋势,同时也具有极高的死亡率,于恶性肿瘤疾病中排名第三[1-3];经调查发现原发性肝癌患者通常合并门静脉高压症,且大部分患者是因食管胃底静脉曲张破裂出血而死亡,尽早实施有效治疗格外重要,而实施治疗的前提在于诊断,为此寻找合适的诊断方法十分重要[4];我院为了探讨彩色多普勒超声对原发性肝癌合并门静脉高压的临床诊断效果,选取2017年3月~2018年3月收治的62例为研究对象进行分析,现报道如下。
  1 资料与方法
  1.1 一般资料
  选取2017年3月~2018年3月收治的研究对象为32例原发性肝癌合并门静脉高压患者设为观察组,纳入标准:(1)经病理学检查确诊为原发性肝癌合并门静脉高压[5];(2)不伴有其他严重疾病,如心血管系统疾病等;(3)进行彩色多普勒超声检查;(4)临床资料完整。排除标准:(1)合并其他系统肿瘤或严重疾病;(2)存在嚴重感染;(3)伴有严重精神类疾患。同期选择32例健康体检人员作为研究对象设为对照组,均选择彩色多普勒超声检查,且观察门静脉主干内径、脾静脉内径、门静脉流量、脾静脉流量、门静脉流速、脾静脉流速及分析门静脉主干内径、脾静脉内径与食管胃底静脉曲张关系。观察组中,男15例、女17例;年龄38~72岁,平均(52.12±1.32)岁;门静脉主干内径:<1.3 cm 12例、1.3~1.4 cm 10例、>1.4 cm共10例;脾静脉内径:<0.9 cm 12例、0.9~1.0 cm 10例、>1.0 cm共10例。对照组中,男16例、女16例;年龄38~72岁,平均(52.12±1.32)岁。两组基本资料(性别、年龄)对比,差异无统计学意义(P>0.05),具有可比性。
  1.2 方法
  所有参与研究的人员未服用或检查前1周停用血管活性药物,于检查前禁食 10 h以上,且尽量排空肠道内气体,以减轻肠道气体的干扰。选择彩色多普勒超声(GE LOGIQ E9)检查,由美国GE公司所提供,探头频率控制为4.0~10.0 MHz;告知受检人员检查当天空腹,以便肠气干扰诊断结果。受检者平卧、左侧卧位于检查床,平静呼吸,检查者对受检者肝脏、脾脏等器官进行检查。
  1.3 观察指标
  观察两组受检人员的门静脉主干内径、脾静脉内径、门静脉流量、脾静脉流量、门静脉流速、脾静脉流速;且分析门静脉主干内径、脾静脉内径与食管胃底静脉曲张关系。
  1.4 统计学方法
  以SPSS22.0分析数据,计量资料采用(x±s)表示,组间比较采用t检验。计数资料采用[n(%)]表示,比较采用χ2检验,等级资料比较采用秩和检验。P<0.05为差异有统计学意义。
  2 结果
  2.1 两组血流动力学指标比较
  观察组门静脉主干内径、脾静脉内径、门静脉流量、脾静脉流量均高于对照组,而门静脉流速、脾静脉流速则低于对照组(P<0.05)。见表1。
  2.2 门静脉主干内径与食管胃底静脉曲张关系
  门静脉主干内径<1.3 cm患者的食管胃底静脉曲张轻度为9例、中度为3例、重度为0例;门静脉主干内径为1.3~1.4 cm患者的食管胃底静脉曲张轻度为2例、中度为5例、重度为3例;门静脉主干内径>1.4 cm患者的食管胃底静脉曲张轻度为2例、中度为2例、重度为6例;随着门静脉主干内径的增加食管胃底静脉曲张程度越严重。见表2。
  2.3 脾静脉内径与食管胃底静脉曲张关系
  脾静脉内径<0.9 cm患者的食管胃底静脉曲张轻度为9例、中度为2例、重度为0例;门静脉主干内径为0.9~1.0 cm患者的食管胃底静脉曲张轻度为3例、中度为6例、重度为2例;门静脉主干内径>1.0 cm患者的食管胃底静脉曲张轻度为1例、中度为2例、重度为7例;随着脾静脉内径的增加食管胃底静脉曲张程度越严重。见表3。
  3 讨论
  原发性肝癌是临床上较为常见的恶性肿瘤疾病之一,具有极高的发病率及死亡率,且死亡率仅次于肺癌与胃癌,即排名第三[6-7];目前临床上尚未明确该病发病机制及病因,仅认为与病毒性肝炎、肝硬化、门静脉高压等具有密切联系[8];经调查发现[9-11]大部分原发性肝癌患者合并门静脉高压,且高达30%患者死于门静脉高压所引起的食管胃底静脉曲张破裂出血,为此尽早实施有效治疗十分重要,对控制病情发展及延长患者寿命具有积极作用;门静脉高压在临床上是指压力持续上升大于24 cmH2O[12-14],同时也被称为门静脉高压症,主要由多种因素共同作用下导致门静脉血流受阻,一旦血液瘀滞,则会促使门静脉压力持续升高,于正常情况下维持于13~24 cmH2O左右;目前临床上选择彩色多普勒超声技术进行检查,是一种较为常用的影像学手段,具有较高的准确性及灵敏度,尤其是对血流动力学变化及心血管疾病等,可为疾病诊断及治疗提供客观依据,对改善预后具有非常重要的临床意义[15-16],因此在临床上得到广泛应用及推广。
  彩色多普勒超声技术具有操作简单、无创伤、重复性好及价格实惠等优点,可用于临床多种疾病的辅助诊断,通过对血流分布、血流方向、血流性质、血流速度等多方面定性或定量分析提供兼具二维超声结构图像信息[17-19];除此之外,还能很好的呈现肝脏、脾脏大小、形态及相关动静脉血流动力等相关指标,即为诊断提供有价值的依据[20-21];本次研究结果中可发现观察组患者的门静脉主干内径、脾静脉内径、门静脉流量、脾静脉流量均高于对照组,而门静脉流速、脾静脉流速则低于对照组(P<0.05),与刘燕等[1]研究结果一致,即观察组门静脉主干内径[(1.50±0.38)cm]、脾静脉内径[(1.12±0.32)cm]、门静脉流量[(985.21±12.52)mL/min]、脾静脉流量(782.32±10.25 mL/min)均高于对照组,而门静脉流速[(7.89±2.32 cm/s)]、脾静脉流速[(9.90±1.52 cm/s)]则低于对照组(P<0.05);由此说明血流动力学指标可作为诊断门静脉高压的辅助指标;并且门静脉主干内径及脾静脉内径与食管胃底静脉曲张程度具有密切相关联系,即门静脉主干与脾静脉内径越宽,则说明食管胃底静脉曲张越严重,具有极高的破裂出血风险,通过给予彩色多普勒超声预测风险,实施相应预防措施,从而降低食管胃底静脉曲张破裂出血风险,对改善预后具有积极作用。   总之,彩色多普勒超声用于原发性肝癌合并门静脉高压中具有较高的临床价值,有利于为疾病诊断及治疗提供客观依据,值得应用及推广。
  
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  (收稿日期:2018-10-12)
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