【作者】 于家傲；

【导师】 孙晓东；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:本研究旨在探讨术前增强CT测量指标:脾动脉直径、脾动脉/肝总动脉直径比值、脾动脉/肝固有动脉直径比值、脾脏体积,对肝移植术后脾动脉盗血综合征发生的预测价值,并确定最佳截断值。方法:纳入自2016年9月至2022年10月间在我中心行首次肝移植手术的166例成年患者,并分为脾动脉盗血组(n=13)及非脾动脉盗血组(n=153)。回顾性收集这些患者的临床资料,并利用术前增强CT图像测量所纳入患者以下指标:脾动脉直径、肝总动脉直径、肝固有动脉直径、脾脏体积,计算得到脾动脉/肝总动脉直径比值、脾动脉/肝固有动脉直径比值。应用单因素及多因素Logistic回归探究这些CT测量指标是否具有SASS的预测价值。用有预测价值的指标绘制受试者工作特征曲线,并确定这些指标的最佳截断值。结果:1)经过Logistic回归分析,结果显示脾动脉直径(OR=1.58,95%CI:1.11～2.25,P<0.05)、脾动脉/肝总动脉直径比值(OR=4.84,95%CI:1.42～16.47,P<0.05)、脾动脉/肝固有动脉直径比值(OR=3.18,95%CI:1.20～8.39,P<0.05),对肝移植术后脾动脉盗血综合征的发生均具有预测价值。分别绘制受试者工作特征曲线,分析显示,脾动脉直径>6.55 mm、脾动脉/肝总动脉直径比值>1.15、脾动脉/肝固有动脉直径比值>1.34分别为这3项指标的最佳截断值。进一步比较3条曲线的曲线下面积,提示脾动脉/肝总动脉直径比值的预测价值最高(AUC=0.714,P=0.012),敏感性为64.7%,特异性为84.6%。2)综合单因素及多因素Logistic回归分析的结果,脾脏体积不具有预测肝移植术后脾动脉盗血综合征的价值(OR=1.00,95%CI:1.00～1.00,P<0.05;Adjusted OR=1.00,95%CI:1.00～1.00,P<0.05)。结论:可以应用脾动脉/肝总动脉直径比值替代脾动脉直径与脾动脉/肝固有动脉直径比值作为指导术中预防脾动脉盗血操作的指标。更多还原

【Abstract】 Objective:This study aimed to explore the predictive value of preoperative enhanced CT measurement indicators,including splenic artery diameter,splenic artery/common hepatic artery diameter ratio,splenic artery/proper hepatic artery diameter ratio,and splenic volume,for the occurrence of splenic artery steal syndrome(SASS)after liver transplantation,and to determine the optimal cut-off values.Methods:166 adult patients who underwent their first liver transplantation at our centre between September 2016 and October 2022 were included and divided into the SASS group(n=13)and the non-SASS group(n=153).We retrospectively collected Clinical data,and the following indicators were measured using preoperative enhanced CT images: splenic artery diameter,common hepatic artery diameter,proper hepatic artery diameter,and splenic volume.The splenic artery/common hepatic artery diameter and splenic/proper hepatic artery diameter ratios were calculated.Univariate and multivariate logistic regression were used to investigate whether these CT measurement indicators had predictive value for SASS.Researchers used the needles with predictive values to construct a receiver operating characteristic curve and determined the optimal cut-off values for these indicators.Results:1)Logistic regression analysis showed that splenic artery diameter(OR=1.58,95%CI:1.112.25,P<0.05),splenic artery/common hepatic artery diameter ratio(OR=4.84,95%CI:1.4216.47,P < 0.05),and splenic artery/proper hepatic artery diameter ratio(OR=3.18,95%CI: 1.20～8.39,P<0.05)all had predictive value for SASS after liver transplantation.The optimal cut-off values for these three indicators were splenic artery diameter >6.55 mm,splenic artery/common hepatic artery diameter ratio >1.15,and splenic artery/proper hepatic artery diameter ratio >1.34,respectively.Further comparison of the three curves showed that the splenic artery/common hepatic artery diameter ratio had the highest predictive value(AUC=0.714,P=0.012),with a sensitivity of 64.7% and specificity of84.6%.2)The combined univariate and multivariate logistic regression analysis results suggest that spleen volume does not have predictive value for postoperative splenic artery steal syndrome after liver transplantation(OR=1.00,95%CI: 1.001.00,P<0.05;adjusted OR=1.00,95%CI: 1.001.00,P<0.05).Conclusion:The splenic artery/common hepatic artery diameter ratio can replace splenic artery diameter and splenic artery/proper hepatic artery diameter ratio as an indicator for guiding intraoperative prevention of splenic artery steal.更多还原