摘要
目的:探讨门静脉测压指导下脾切除联合选择性断流术治疗肝硬化门脉高压症的临床疗效。方法:回顾性分析102例肝硬化门静脉高压症手术患者的临床资料和随访资料,其中实施门静脉测压指导下脾切除联合选择性断流术者32例作为观察组,实施传统断流术者70例作为对照组。对比两组手术时间、术中出血量、手术前后自由门静脉压(FPP)和肝功能Child-Pugh评分、上消化道再出血、各级门静脉血栓形成及胃排空延迟等术后并发症发生率。结果:观察组和对照组手术时间分别为(232.53±36.45)min和(317.36±56.23)min;术中出血量分别为(196.75±20.42)ml和(382.36±34.87)ml,观察组明显低于对照组,差异具有统计学意义(t=2.362、3.286,均P<0.05);观察组和对照组术后上消化道再出血发生率分别为6.25%(2/32)和24.3%(17/70),Ⅰ/Ⅱ级门静脉血栓发生率分别为12.5%(4/32)和31.4%(22/70);胃肠道排空延迟发生率分别为3.12%(1/32)和14.3%(10/70);观察组明显低于对照组,差异具有统计学意义(χ2=4.292、4.027、3.935,均P<0.05);两组术后Ⅲ/Ⅳ级门静脉血栓发生率分别为3.12%(1/32)和5.71%(4/70),差异无统计学意义(P>0.05)。两组术前的FPP和Child-Pugh评分比较差异无统计学意义(P>0.05),两组术后的FPP和Child-Pugh评分均较术前明显改善,但观察组改善情况明显优于对照组,差异具有统计学意义(P<0.05)。结论:门静脉测压指导下的脾切除联合选择性断流术治疗肝硬化门静脉高压症在降低FPP及术后上消化道再出血风险,改善肝功能及手术安全性方面要优于传统断流手术,值得临床推广应用。
Objective To investigate the clinical curative effect of portal hypertension treated by splenectomy combined selective devascularization guided under the portal vein pressure. Method Retrospectively analyzed the clinical data of 102 patients with cirrhotic portal hypertension,including the splenectomy combined selective devascularization guided under the portal vein pressure 32 cases as observation group,the traditional devascularization 70 cases as control group. The operation time,intraoperative blood loss,free portal pressure（ FPP） and liver function Child-Pugh score,recurrent upper gastrointestinal bleeding,gastrointestinal emptying delay,portal vein thrombosis of the two groups were compared. Results The operation time of the observation group and control group respectively was（ 232. 53 ± 36. 45） min vs（ 317. 36 ± 56. 23） min; intraoperative blood loss respectively was（ 196. 75 ± 20. 42） ml vs（ 382. 36 ± 34. 87） ml,the observation group was significantly lower than the control group,there was statistically significant difference（ t = 2. 362,3. 286,P〈0. 05）; Incidence of recurrent upper gastrointestinal bleeding of observation group and control group respectively was 6. 25%（ 2/32） vs 24. 3%（ 17/70）,Ⅰ/Ⅱ level portal vein thrombosis respectively was 12. 5%（ 4/32） vs 31. 4%（ 22/70）; gastrointestinal emptying delay respectively was 3. 12%（ 1/32） vs 14. 3%（ 10/70）; the observation group was significantly lower than the control group,there was statistically significant difference（ χ2= 4. 292,4. 027,3. 935,P〈0. 05）; The incidence of the Ⅲ/Ⅳ level portal vein thrombosis of the two groupsrespectively was 3. 12%（ 1/32） vs 5. 71%（ 4/70）,there was no statistically significant difference（ P〈0. 05）. The preoperative FPP and Child-Pugh score of the two groups had no statistically significant difference（ P〈0. 05）,the postoperative FPP and Child-Pugh scores of the two groups were obviously than the preoperative,but improve situation of the observation group was better than control group,the difference was statistically significant（ P〈0. 05）. Conclusion Splenectomy combined selective devascularization guided under the portal vein pressure in treatment of portal hypertension can reduce the FPP and the risk of recurrent upper gastrointestinal bleeding,improve liver function and the operation safety is superior to the traditional devascularization operation,worthy of clinical popularization and application.
出处
《吉林医学》
CAS
2017年第1期26-30,共5页
Jilin Medical Journal
基金
四川省人民医院青年基金项目[项目编号:30305030611]
关键词
门静脉高压症
脾切除术
选择性断流术
自由门静脉压
Portal hypertension
Splenectomy
Selective devascularization
Freedom portal pressure
