本文選題：乙型肝炎 + 肝硬化�。� 參考：《遵義醫(yī)學院》2013年碩士論文

【摘要】：目的：通過對乙肝后肝硬化脾功能亢進(hypersplenism,簡稱脾亢)患者脾動脈與正常脾臟脾動脈數(shù)字減影血管造影(Digital subtraction angiography, DSA)表現(xiàn)的對比研究,探討乙肝后肝硬化脾亢患者脾動脈的DSA征象,為脾亢患者DSA診斷及介入治療提供參考。 方法：1、研究分組：乙肝后肝硬化脾亢組(脾亢組)和正常脾臟組(對照組)。脾亢組：接受部分脾動脈栓塞術(shù)(Partial splenic embolization, PSE)治療的乙肝后肝硬化脾亢患者60例,按照脾臟腫大程度劃分,輕度腫大15例,中度24例,重度21例。對照組：因肝臟病變接受介入治療的正常脾臟患者20例,其中肝血管瘤18例,肝損傷出血2例。 2、兩組病例DSA資料的相關(guān)數(shù)據(jù)收集、整理：將脾動脈全程分為脾外段和脾內(nèi)段兩部分,觀察脾外段動脈主干的形態(tài)及脾內(nèi)段動脈血管分支、分布及其他情況,測量脾外段脾動脈主干長度、管徑、血液分流量及脾內(nèi)段血管分支密集度。 3、采用SPSS17.0統(tǒng)計軟件分析,兩組間比較采用t檢驗,各組間計量資料比較用單因素方差分析,等級資料比較用秩和檢驗,各計量參數(shù)間相關(guān)性分析用Pearson積矩相關(guān)分析,計算結(jié)果PO.05為差異有統(tǒng)計學意義,P0.01為有顯著差異。 結(jié)果：脾亢組脾臟體積測量與入院時血細胞計數(shù),組間比較差異無統(tǒng)計學意義(P0.05)。脾亢組與對照組脾外段脾動脈主干迂曲情況,脾亢組脾外段動脈主干均有不同程度的迂曲,其中重度迂曲15例,而對照組只有1例,兩組比較差異有統(tǒng)計學意義(P=0.000),脾動脈主干迂曲程度與脾臟腫大程度密切相關(guān)(P=-0.012,r=0.322)。脾外段動脈主干測量指標比較：其中脾外段動脈主干長度及肝動脈管徑測量值比較,差異無統(tǒng)計學意義(P值分別是0.592、0.372)；脾外段動脈主干管徑、脾肝動脈管徑比值及脾動脈血流量測量值比較差異均有統(tǒng)計學意義(P值均為0.000),即脾亢組脾外段動脈主干管徑增粗、脾肝動脈管徑比值增大及脾動脈血流量增加,且與脾臟腫大程度呈正相關(guān)(相關(guān)系數(shù)r值分別為0.773、0.403、0.918)。脾亢組與對照組脾內(nèi)段動脈觀測值,兩組資料脾葉動脈血管管徑、血管分支密集度比較,差異有統(tǒng)計學意義(P值分別為0.047、0.041),即脾亢組脾葉動脈管徑較對照組增粗,血管分支密集度減低,且分別與脾臟腫大程度呈正相關(guān)和負相關(guān)(相關(guān)系數(shù)r分別為0.811、-0.768)。脾亢組脾內(nèi)段動脈發(fā)生動脈瘤樣改變8例21處,中度脾大有3例7處,重度脾大有5例14處,輕度脾大組和對照組未發(fā)現(xiàn)類似表現(xiàn)。 結(jié)論：乙肝后肝硬化并發(fā)脾亢會加重脾外段脾動脈主干走行迂曲、管徑增粗,其增粗、迂曲程度與脾臟體積增大程度密切相關(guān)；脾肝動脈管徑比值增大,脾動脈血液分流量增多；脾內(nèi)段脾葉動脈增粗,血管分支密集度減低,可出現(xiàn)脾動脈瘤樣改變。
[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 鹵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.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R512.62

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