部分脾切除在晚期血吸虫肝硬化巨脾症患者的临床应用  

The clinical application of partial splenectomy in advanced schistosomiasis cirrhosis megalosplenia

作　　者：王雄彪 柯昌松 肖绪鹏 柯松 

机构地区：[1]湖北省阳新县人民医院普外科,435200

出　　处：《中华实验外科杂志》2013年第12期2698-2700,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 探讨部分脾切除术治疗晚期血吸虫肝硬化巨脾症的疗效.方法 将22例晚期血吸虫巨脾症手术患者随机分对照组（11例）和研究组（11例）,对照组行脾切除,研究组行部分脾切除,观察两组术后24h脾窝渗血量,检测术前50 d、术后50 d两组免疫指标促吞噬肽（tuftsin）和IgM量,测量术前1周和术后1年两组患者门静脉流量,检验术后1周、1个月患者白细胞、血小板、肝功能变化,随访5年再出血率及生活质量.结果 对照组术后24h脾窝渗血量为（600 ±50） ml,明显高于研究组[（100±25）ml,P＜0.05];检测血清tuftsin及IgM：对照组术前50 d分别为（278.6±13.80）、（2.93±1.42） μg/L,术后50 d（107.4 ±9.09）、（1.45±0.41） μg/L,两种免疫指标明显下降,而研究组术前50 d[（280.7±14.50）、（2.41 ±1.07） μ/L],术后50 d[（277.5 ±7.03）、（2.70 ±0.91） μg/L],比较无下降,组间差异有统计学意义（P＜0.05）.门静脉流量术前研究组为（1.23±0.11） cm2,术后1年为（0.85 ±0.15） cm2,而对照组术前为（1.19±0.18） cm2,术后1年为（1.03 ±0.19） cm2,两组均下降,且研究组少于对照组,而白细胞、血小板、肝功能变化及5年再出血率、生活质量比较差异均无统计学意义（P＞0.05）.结论 部分脾切除治疗晚血巨脾症术式可行,且术后创面渗血少,降低手术风险,又保留脾脏的免疫功能,防范脾术后凶险感染.此术式还可起到自发性分流作用.Objective To evaluate the efficacy of partial splenectomy in the treatment of advanced schistosomiasis cirrhosis megalosplenia.Methods 22 patients with advanced schistomiasis megalosplenia were equally divided into two groups at random.11 patients in experimental group were performed partial splenectomy,and another 11 patients in control group were performed splenetcomy,we obeserved splenic nest oozing blood volume of two groups in postoperative 24 hours and detected immunologic quota including tuftsin and IgM of two groups in preoperative and postoperative 50 days respectively.The portal vein flow of two groups＇ patients were measured in preoperative one week and postoperative one year.Biochemical changes including WBC,Platelet,Liver function were examined in preoperative one week and one month respectively.Patients were revisited for the rate of recurrence of hemorrhage in 5 years and the quality of life.Results The splenic nest oozing blood volume in the control group （600 ± 50） ml is higher than the experimental group （100±25） ml obviously （P ＜0.05）.The tuftsin and IgM of the control group in preoperative and postoperative 50 days are detected respectively （278.6 ± 13.80）,（2.93 ± 1.42） μg/L and 107.4 ±9.09）,（1.45 ±0.41） μg/L,both of the immunologic quota declined evidently.But the detection of experimental group in preoperative 50 days （280.7 ± 14.50）,（2.41 ± 1.07） μg/L and postoperative 50 days （277.5 ±7.03）,（2.70 ±0.91） μg/L have no decline.Differences between the two groups was significant （P ＜ 0.05）.The portal vein flow of the experimental group before operation and in postoperative one year is （1.23 ±0.11） cm2 and （0.85 ±0.15） cm2,and the flow of the contol group before operation and in postoperative one year is （1.19 ±0.18） cm2 and （1.03 ±0.19） cm2.Both of the flow of the two group decreased,and the flow in experimental group is less than in control group.There is no statistical differences in WBC,Platelet,liver functi

关 键 词：部分脾切除 晚期血吸虫肝硬化 巨脾症 临床疗效 

分 类 号：R657.6[医药卫生—外科学]