脾切除并门奇静脉断流术术前行选择性脾动脉栓塞的临床应用价值  

Clinical practice value of partial splenic embolization before the combined splenectomy and portal azygous disconnection for treatment of portal hypertension

作　　者：朱盛兴[1] 张俊杰[1] 张应选[1] 

机构地区：[1]河南省郑州人民医院普三科,河南郑州450053

出　　处：《中国现代医学杂志》2014年第2期74-77,共4页China Journal of Modern Medicine

摘　　要：目的探讨肝硬化门静脉高压症脾切除并门奇静脉断流术术前选择性脾动脉栓塞的临床应用价值。方法选择肝硬化并上消化道出血患者158例,随机分为脾栓塞组（n=77）与非脾栓塞组（n=81）。脾栓塞组行选择性脾动脉栓塞（PSE）,栓塞面积65%~75%,1周后行脾切除并门奇静脉断流术;非脾栓塞组直接行脾切除并门奇静脉断流术。结果两组入选患者入组资料无差异（P〉0.05）。脾栓塞组脾栓1周后血小板恢复正常,白细胞、血红蛋白上升,凝血酶原时间缩短,脾切除并门奇静脉断流术术前临床检验指标明显优于非脾栓塞组（P〈0.01,P〈0.05）;手术出血量、输血量、血小板输注量、并发症发生率等指标明显优于非脾栓塞组（P〈0.05）。康复出院前两组患者临床检验指标差异无统计学意义（P〉0.05）。结论脾切除并门奇静脉断流术术前先行脾动脉栓塞,可以使脾功能亢进得以恢复,增强了患者的手术耐受性,降低了手术风险,减少了并发症发生率。[Objective] To evaluate the significance and clinical practice value of selective partial splenic embolization before the splenectomy and portal azygous disconnection for treatment of portal hypertension. [Methods] The upper gastrointestinal bleeding patients （n =158） suffered from cirrhosis and portal hyperten- sion were randomly divided into two groups. The selective partial splenic embolization group （n =77, group A） which was performed with selective partial splenic embolization and the embolization extent to 65-75% and then was taken splenectomy with periesophagogastric devascularization after a week. The non-partial splenic embolization group （n =81, group B） was performed with splenectomy with periesophagogastric devascularization directly. SAS 8.0 software was used for statistical analysis. [Results] There were no significant differences in clinical materials of group A and group B （P〉O.05）, The clinical laboratory data of group A is better than group B a week later （P〈0.O1, P〈0.05）, whose platelet can return to normal, the number of white blood cell and hemoglobin can increase and the prothrombin time is shortened. The other clinical laboratory data of group A is better than group B to（）, which include bh）od loss during operation, blood transfusion, complica- tions and so on （P〈0.05）. There were no significant differences in clinical materials of group A and group B before the patients discharge from Hospital （P〉0.05）. [Conclusion] The upper gastrointestinal bleeding pa- tients who were suffering from cirrhosis and portal hypertension should be performed with selective partial splenic embolization before taken splenectomy with periesophagogastric devascularization after a week, which can make hypersplenism recover. So it can strengthen the tolerance of the patients, reduce the risk of the op- eration and lower the incidence of complications.

关 键 词：肝硬化 脾功能亢进 选择性脾栓塞术 脾切除 门奇静脉断流术 

分 类 号：R575.2[医药卫生—消化系统]