脾大部切除加断流术治疗肝硬变门静脉高压症的远期疗效  

Long-term effects of subtotal splenectomy plus pericardial devascularization on portal hypertension due to cirrhosis.

作　　者：杨新华[1] 马宏敏[1] 蔡志民[1] 

机构地区：[1]第三军医大学附属西南医院普外科,重庆400038

出　　处：《中国实用外科杂志》1999年第12期723-724,共2页Chinese Journal of Practical Surgery

摘　　要：目的　探讨治疗门静脉高压症的新术式。方法　对36 例肝硬变门静脉高压症病人行脾大部切除加断流术,并进行远期随访。结果　术后门静脉压力平均下降0-68kPa 。近期并发左胸腔积液9 例,左膈下积液10例,1 例上消化道出血,无手术死亡。术后1 年内绝大多数病人脾亢和食道静脉曲张改善或消失,B 超和γ- 照相显示残脾无明显增大,有吞噬功能。随访1 ～10 年,出现上消化道大出血、肝性脑病及死亡各2 例,1 年、3 年和5年生存率分别为100 % 、96-5 % 和95-7 % 。结论　该术式治疗门静脉高压症疗效可靠。Objective To evaluate a new surgical treatment for portal hypertension due to cirrhosis.Methods Thirty-six patients with cirrhosis and portal hypertension were followed up after subtotal splenectomy plus pericardial devascularization. Results The average portal pressure reduction was 0 68kPa.Operative complications:9 cases of left hydrothorax,10 cases of left subphrenic hydrops and one hemorrhage of upper digestive tract.No one died of operation.In the first year after operation,hypersplenism and esophageal varicosis disappeared or took a turn for the better,B type ultrasonic examination and γ-scintigraphy showed that the residual spleen did not enlarge and had phagocytic function.All patients were followed up for 1～10 years,2 had upper digestive tract hemorrhage,2 had hepatic encephalopathy and 2 patients died.The 1-, 3- and 5-year survival rates after operation were 100%,96 5% and 95 7% respectively.Conclusion Subtotal splenectomy plus pericardial devascularization is effective in the treatment of portal hypertension due to cirrhosis.

关 键 词：脾切除术 肝硬化 门脉高压症 断流术 

分 类 号：R657.340.5[医药卫生—外科学] R657.6[医药卫生—临床医学]