对于脾肿大和脾功能亢进的门脉高压患者,脾切除术是减轻并发症的有效手术。然而,接受脾切除术的患者经常患有门静脉系统血栓,需要预防和及时治疗以避免恶化和死亡的后遗症。本研究旨在探讨基于计算模型的血流动力学指标预测脾切除术后血栓形成的可行性。首先,15例接受脾切除术的门脉高压患者被纳入,收集患者术前临床资料及术后随访结果。接下来,基于术前计算机断层扫描血管造影图像和超声测量的血流速度,构建了门静脉系统的计算模型。在此基础上,模拟脾切除术,并模拟每个患者特定模型的术后低壁面切应力(ALWSS)区域.最后,将模型模拟ALWSS与患者随访结果进行统计学比较,以探讨使用血流动力学指标预测脾切除术后血栓形成的可行性.结果表明,ALWSS可以预测脾切除术后血栓的发生,受试者工作特征曲线下面积(AUC)等于0.75。此外,统计分析提示脾静脉直径与ALWSS呈正相关(r=0.883,p<0.0001),门静脉系统的解剖结构也影响ALWSS。这些发现表明,基于计算模型的血液动力学指标ALWSS,这与门静脉系统的解剖形态学特征有关,能够预测脾切除术后血栓形成的发生,促进更好的预防和术后管理门脉高压患者接受脾切除术。
For portal hypertensive patients with splenomegaly and hypersplenism, splenectomy is an effective surgery to relieve the complications. However, patients who have undergone splenectomy often suffer from portal venous system thrombosis, a sequela that requires prophylaxis and timely treatment to avoid deterioration and death. The aim of this
study is to investigate the feasibility of predicting post-splenectomy thrombosis using hemodynamic metrics based on computational models. First, 15 portal hypertensive patients who had undergone splenectomy were enrolled, and their preoperative clinical data and postoperative follow-up results were collected. Next, computational models of the portal venous system were constructed based on the preoperative computed tomography angiography images and ultrasound-measured flow velocities. On this basis, splenectomy was mimicked and the postoperative area of low wall shear stress (ALWSS) was simulated for each patient-specific model. Finally, model-simulated ALWSS was statistically compared with the patient follow-up results to investigate the feasibility of predicting post-splenectomy thrombosis using hemodynamic metrics. Results showed that ALWSS could predict the occurrence of post-splenectomy thrombosis with the area under the receiver operating characteristic curve (AUC) equal to 0.75. Moreover, statistical analysis implied that the diameter of the splenic vein is positively correlated with ALWSS (r = 0.883, p < 0.0001), and the anatomical structures of the portal venous system also influence the ALWSS. These findings demonstrated that the computational model-based hemodynamic metric ALWSS, which is associated with the anatomorphological features of the portal venous system, is capable of predicting the occurrence of post-splenectomy thrombosis, promoting better prophylaxis and postoperative management for portal hypertensive patients receiving splenectomy.