保留脾脏的选择性断流联合脾肾静脉桥式分流术对肝硬化合并门静脉高压患者免疫功能的影响  

Effects of spleen-preserving selective devascularization followed by splenorenal venous bridge shunt operation on immune function of patients with cirrhosis and portal hypertension

作　　者：李小珍[1] 罗地来[1] 朱程[1] 涂黄[1] 祝海锋[1] 邹书兵[1] 

机构地区：[1]南昌大学第二附属医院肝胆外科,江西南昌330006

出　　处：《重庆医学》2013年第1期24-26,30,共4页Chongqing medicine

摘　　要：目的探讨保留脾脏的选择性断流联合脾肾静脉桥式分流术治疗肝硬化合并门静脉高压对患者免疫功能的影响。方法选择51例肝硬化合并门静脉高压患者进行研究,将患者按手术方式分为联合组(接受保留脾脏的选择性断流联合脾肾静脉桥式分流术治疗的患者,n=21)及离断组(接受切除脾脏的贲门周围血管离断术的患者,n=30)。比较手术前、后两组患者外周血白细胞、血小板、免疫球蛋白(IgG、IgA、IgM)及T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)的水平。结果与术前比较,术后两组患者外周血白细胞、血小板均明显升高(P<0.05)。但术后1周,离断组患者外周血血小板较联合组升高更明显(P<0.05);术后4周两组达正常范围,差异无统计学意义(P>0.05)。与术前比较,术后联合组患者外周血IgM升高(P<0.05),而离断组降低(P<0.05)。与术前比较,术后离断组患者外周血CD4+及CD4+/CD8+降低(P<0.05),联合组患者外周血CD4+、CD8+、CD4+/CD8+变化不大(P>0.05)。术后联合组患者外周血CD4+、CD4+/CD8+高于离断组(P<0.05)。结论保留脾脏的选择性断流联合脾肾静脉桥式分流术治疗肝硬化合并门静脉高压能缓解患者脾功能亢进,改善免疫功能。Objective To investigate effects of spleen preserving selective devascularization followed by splenorenal venous bridge shunt operation on immune function of patients with cirrhosis and portal hypertension. Methods 51 cases of cirrhosis and portal hypertension were collected, and divided into combination group（patient receiving spleen-preserving selective devasculariza- tion followed by splenorenal venous bridge shunt operation,n=21） and devascularization group（patient receiving pericardial devas eularization with splenectomy, n ： 30） according to surgical procedures. Pre- and post-operative levels of leukocytes, platelets,immu noglobulin（IgG, IgA,IgM） and T lymphocyte subsets（CD4＋ , CD8＋ , CD4＋/CD8＋ ） in peripheral blood of patients in both groups were compared. Results Compared to pre-operation,post-operative leukocytes and platelets in peripheral blood of patients in both groups increased（P〈0.05）. Platelets in peripheral blood of patients in devascularization group increased more than those in combi nation group one week after operation（P〈0.05）, and platelets in both groups reached the normal range 4 weeks after operation with no statistical difference（P〉0.05）. Compared to pre-operation,post-operative IgM in peripheral blood of patients in combination group increased （ P 〈 0.05 ）, and decreased, in devascularization group （ P〈0.05 ）. Compared to pre-operation, post-operative CD4＋ and CD4＋/CD8＋ in peripheral blood of patients in devascularization group reduced （P〈0.05） and CD4＋ , CD8＋, CD4＋ / CD8＋ showed little change in combination group（P〉0.05）. Post-operative CD4＋ and CD4＋/CD8＋ in peripheral blood of patients in combination group were higher than those in devascularization group（P〈0.05）. Conclusion Treatment of portal hypertension with spleen-preserving selective devascularization followed by splenorenal venous bridge shunt operation can relieve patients from hypersplenism and improve their immune function.

关 键 词：脾肾分流术 外科 高血压 门静脉 肝硬化 免疫球蛋白类 T淋巴细胞 

分 类 号：R657.3[医药卫生—外科学]