改良Sugiura手术加自体脾移植治疗门静脉高压症的临床研究  

Clinical study of modified sugiura procedure plus spleen autotransplatation in the treatment of portal hypertension

作　　者：张始业[1] 段升军[1] 吕德泉[1] 王春祥[1] 孙孝东[1] 

机构地区：[1]济南市第三人民医院普外科,山东济南250101

出　　处：《中国现代普通外科进展》2008年第6期504-507,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:评价改良Sugiura手术加自体脾移植治疗门静脉高压症的效果。方法:应用改良Sugiura手术加自体脾移植治疗门静脉高压症患者45例(研究组),与同时期45例行贲门周围血管离断术的患者(对照组)进行对比研究。结果:研究组术后无死亡病例,近期止血效果确切,随访时间0.5～4年,肝性脑病发生率为4.4%(2/45),再出血率为2.2%(1/45);术后所有患者食管下段静脉曲张消失或明显好转;术后再出血率及静脉消失率两组比较差异均有统计学意义(P<0.05)。研究组术后2个月血清Tuftsin和IgM水平下降不显著,术后随访移植脾块同位素显像呈阳性,而对照组无阳性显像。结论:改良Sugiura手术加部分自体脾移植手术操作较简单、再出血率低、并发症少且保留脾脏的免疫功能,是一种值得推广的治疗门静脉高压症手术方法。Objective： To evaluate the effect of modified Sugiura procedure plus spleen autotransplantation in treatment of portal hypertension. Methods： From 2003 to 2007,45 patients with portal hypertension underwent modified Sugiura procedure plus spleen autotransplantation, and 45 patinets underwent pericardial devascularization. Results： There was no postoperational mortality. The immediate effect on the hemorrhage and recent response of the patients were satisfactory. After 0.5 years to 4 years of follow up, the hepatic encephalopathy incidence was 4.5% and recurrent variceal bleeding ratio was 2.2%. All patients showed that esophageal varices disappeared or remarkably ameliorated. There were significant difference of recurrent variceal bleeding rate between two groups.The preoperative levels of serum Tuftsin and IGM showed no statistical difference between groups, However serum tuftfin and IGM decreased remarkably in the control group. The autotransplantation group showed the trans- planted splenic fragment during follow-up. Conclusions： Modified Sugiura procedure plus spleen autotransplantation is relatively simple. The rate of complication, rebleeding is low. At the same time the sp enic immune function were presreved. It＇s a deserved popu arized method .

关 键 词：高血压 门静脉 改良SUGIURA手术 移植 自体 脾 

分 类 号：R657.6[医药卫生—外科学]