脾切除术对肝炎后肝硬化患者肝癌发生的影响  

The Effect of Splenectomy on Liver Cirrhosis in Patients with Hepatocellular Carcinoma Incidence

作　　者：余灵祥[1] 李志伟[1] 郭晓东[1] 肖朝辉[1] 赵德希[1] 孙佳轶[1] 张培瑞[1] 张绍庚[1] 

机构地区：[1]解放军第302医院,北京100039

出　　处：《现代生物医学进展》2013年第10期1959-1961,共3页Progress in Modern Biomedicine

摘　　要：目的:观察脾切断流术对肝硬化门静脉高压症患者肝功的影响。方法:回顾分析2010.4-2011.12在我科住院的肝硬化门静脉高压症患者行脾切除术前后肝功能的变化。应用超声多普勒分别检测手术前后门静脉血流量(PVF)、肝动脉血流量(HAF),术中水柱法测量自由门静脉压力(FPP);回顾分析(通过对病历查阅获取)上述患者Child分级指标以及肝功能指标。用SAS 8.0对获取的指标采用配对资料t检验和卡方检验。结果:肝硬化门静脉高压症患者共480例,行脾脏切除加贲门周围血管离断术450例,单纯脾切除30例。PVF由术前的(1368±402)ml/min减少至术后的(986±295)ml/min(P<0.01);HAF由术前的(412±68)ml/min增加至术后的(526±132)ml/min(P<0.01);FPP由术前的(30±6)cm H2O降至术后的(26±5)cm H2O(P<0.01)。R15 ICG由术前的(18±8)%降至术后的(16±7)%(P>0.05)。肝功能Child分级A级患者比率由术前85%增加至术后95%(P<0.01)。其它肝脏功能指标如总胆红素、凝血酶原延长时间以及腹水消失率都明显好转。结论:脾切断流术后门静脉血流量虽然减少,但是肝动脉血流量增加及术后门体分流减少均有利于肝功能恢复。Objective： To investigate the liver function of liver cirrhosis patients with portal hypertension after spenectomy.Methods： Liver cirrhosis patients with portal hypertension in Division Ⅰ,First Hepatobiliary Surgery Center,302 Hospital was enrolled in our study from April 2010 to December 2011.Clinical data were analyzed retrospectively.Results： A total of 480 liver cirrhosis patients with portal hypertension was conducted with splenectomy,including 450 cases with splenectomy combined with pericardial devascularization,30 cases with splenectomy alone.Portal venous flow（PVF） and free portal vein pressure（FPP） were decreased（1368±402 vs 986±295 ml/min,30±6 vs 26±5 cm H2O,respectively） and hepatic blood flow（HAF） was increased（412±68 vs 526±132 ml/min） after operation.R15 ICG was tended to be decreased though no significance was reached.Additionally,the proportion of patients with Child Pugh class A was increased from 85% to 95% after splenectomy.Other indicators such as total bilirubin（TBil）,prothrombin time（PT）,and ascites disappearance were also improved after operation.Conclusion： Increase of HAF and decrease of portal systemic shunting were conducive to recoveryr of liver function although PVF was decreased after splenectomy.

关 键 词：肝癌发生 肝炎肝硬化 脾切除术 

分 类 号：R575.2[医药卫生—消化系统] R735.7[医药卫生—内科学]