肝硬化门静脉高压症232例手术治疗的临床与病理研究  

A clinical and pathological study of surgical therapy for the patients with portal hypertension complicating cirrhosis of liver

作　　者：李文淑[1] 孙艳玲[1] 潘登[1] 赵妮娜[1] 张宇[1] 周光德[1] 徐晨[1] 李志伟[1] 闫慧颖[1] 赵景民[1] 

机构地区：[1]解放军第302医院,北京100039

出　　处：《解放军医学杂志》2004年第7期638-639,641,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的　评估贲门周围血管离断术(EED)加脾切除对肝硬化门静脉高压症 (PH)并脾功能亢进的疗效及影响因素 ,并探讨慢性淤血性脾肿大 (CCS)的脾纤维化机制。方法　分析 2 32例肝硬化PH并脾功能亢进实施EED加脾切除术治疗病例的临床资料 ,并采用组织病理观察、抗波形蛋白(Vm)、α 平滑肌肌动蛋白 (α SMA)及CD6 8免疫组织化学方法研究CCS脾纤维化改变。结果　 2 32例术后 (出院时)外周血PLT、WBC、PTA及血清Alb指标较术前均明显改善 (P<0 0 1或P <0 0 5 ) ,仅 2 5 9%患者发生术后并发症 ,经处理后均痊愈出院。切除脾脏体积 14 2 3 6 7± 738 6 9cm3 ,CCS脾组织内Vm阳性成纤维细胞、α SMA阳性肌纤维母细胞明显增多 ,CD6 8阳性巨噬细胞比例增加。结论　EED加脾切除术是解除肝硬化患者脾功能亢进、缓解PH、减少食管胃底静脉曲张出血的有效治疗手段之一 ;注重围手术期及术中护理是保证手术效果的重要环节 ;巨噬细胞系统的活化 ,成纤维细胞。Objective To assess the efficacy of extensive esophagogastric devascularization with splenectomy for surgical treatment of portal hypertension complicating cirrhosis of liver, and to explore the pathogenesis of chronic congestive splenomegaly. Methods A retrospective analysis of clinical data of 232 patients of portal hypertension complicating cirrhosis of liver having undergone extensive esophagogastric devascularization with splenectomy was made. Pathological alterations and extracellular matrix productive cells of the congestive splenomegaly were studied both immunohistochemically and histologically. Results The functional markers including the numbers of PLT, WBC, and PTA in the peripheral blood and serum Alb were significantly improved after the operation compared with that of before the operation. Careful pre-operation preparation, replenishment of blood loss during the operation, postoperative drainage of the splenic bed, and prevention of complications were efficiently carried out. The mean volume of CCS spleens was 1 423.67±738.69cm 3. There was an obvious increase in the numbers of vimentin-, α-SMA-positive cells in the CCS tissues, as well as CD68-positive macrophages. Conclusions The results indicated that extensive esophagogastric devascularization with splenectomy was a reasonably effective alternative therapy for patients with portal hypertension complicated by esophageal varices and congestive splenomegaly. Adequate replacement of blood lost in prevention of operation and postoperative complications were essential for satisfactory recovery of the petient. The activation of macrophagic system, with proliferation of fibroblasts and myofibroblasts, might participate in the pathogenesis of congestive splenomegaly.

关 键 词：门静脉高压症 肝硬化 贲门周围血管离断术 脾切除 病理 

分 类 号：R657.34[医药卫生—外科学]