肝炎后肝硬化门静脉高压症患者附脐静脉开放的临床意义  

Clinical significance of recanalized paraumbilical vein in hepatitis cirrhosis with portal hypertension

作　　者：邝乃乐[1,2] 潘楚芝[1] 林楠[1] 潘卫东[1] 

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630 [2]广东省江门市中心医院肝胆外科

出　　处：《中华肝脏外科手术学电子杂志》2012年第1期40-43,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨附脐静脉开放对肝炎后肝硬化门静脉高压症患者的临床意义。方法回顾性分析中山大学附属第三医院肝胆外科收治的738例肝炎后肝硬化门静脉高压症患者的临床资料,患者均签署知情同意书,符合医学伦理学规定。根据彩色多普勒超声探查附脐静脉开放情况,将其分为开放组和非开放组,采用χ2检验、秩和检验等分析附脐静脉开放与食管胃底静脉曲张程度、出血发生率、肝功能Child￣Pugh分级、腹水发生率的关系。结果开放组患者324例,占43.9%,非开放组患者414例,占56.1%。在开放组和非开放组中,中、重度食管静脉曲张患者分别为17例(10.4%)、101例(61.6%)和22例(10.2%)、123例(56.9%),胃底静脉曲张患者分别为92例(56.1%)和102例(47.2%),食道胃底静脉曲张破裂出血患者分别为20例(6.2%)和32例(7.7%),两组比较差异均无统计学意义(均为P>0.05);开放组中肝功能Child￣Pugh分级A、B级和C级患者分别为68例、178例、78例,分别占21%、54.9%和24.1%,而非开放组分别为193例、144例、77例,分别占46.6%、34.8%和18.6%,开放组中肝功能B、C级患者所占比例较非开放组显著升高,两组比较差异有统计学意义(P<0.01);两组腹水发生率分别为59.2%(143/414)和34.6%(192/324),比较差异有统计学意义(P<0.01)。结论肝炎后肝硬化门静脉高压症患者附脐静脉开放率较高。附脐静脉开放与食管胃底静脉曲张的程度及出血发生率无关。附脐静脉开放与腹水发生率和肝功能损害严重程度相关,附脐静脉开放提示患者易于出现腹水,而且其肝功能受损严重。Objective To study the clinical significance of recanalized paraumbilical vein in hepatitis cirrhotic patients with portal hypertension. Methods Clinical data of 738 patients with hepatitis cirrhosis and portal hypertension from the Third Affiliated Hospital of Sun Yet-sen University were analyzed retrospectively. Local ethical committee approval had been received and that the informed concent of all participating subjects was obtained. Seven hundred and thirty-eight patients were divided into recanalized group and non-recanalized group according to recanalized paraumbilical vein detected by color Doppler ultrasound. The correlations between paraumbilical vein and the degree of esophageal and gastric varices, the incidence of hemorrhage, liver function and ascites were analyzed by the chi-square test and rank sum test. Results There were 324 patients（43.9%） in the recanalized group while 414 patients（56.1%） in the non-recanalized group. There were 17 cases（10.4%） with moderate esophageal varices and 101 cases（61.6%） with severe esophageal varices in the recanalized group while 22 cases（10.2%） and 123 cases（56.9%） in the non-recanalized group respectively. There were 92 cases（56.1%） and 102 cases（47.2%） with gastric varices, 20 cases（6.2%） and 32 cases（7.7%） with variceal hemorrhage in the recanalized and non-recanalized group respectively. There was no significant difference between two groups in the degree of esophageal and gastric varices and the incidence of variceal hemorrhage （all in P〉0.05）. For the liver function grading （Child-Pugh classification） of the recanalized group, 68（21%） patients were grade A, 178（54.9%） patients were grade B, and 78 （24.1%）patients were grade C. For the non-recanalized group, 193 （46.6%） patients were grade A, 144 （34.8%） patients were grade B, 77 （18.6%） patients were grade C. The percentage of grade B and C patients in the recanalized group were markedly higher than that in the non-recanalized group. Th

关 键 词：肝炎后肝硬化 门静脉高压症 附脐静脉 

分 类 号：R575.2[医药卫生—消化系统]