脾大部切除脾肺固定术治疗门脉高压症的评价  

Evaluation of subtotal splenectomy and splenopulmopexy in the treatment of portal hypertension

作　　者：黄凤瑞[1] 

机构地区：[1]解放军89医院普外中心,山东潍坊261000

出　　处：《腹部外科》2001年第4期201-203,共3页Journal of Abdominal Surgery

摘　　要：目的　探讨脾大部切除脾肺固定术治疗门脉高压症的效果 ,寻找门脉高压症外科治疗新方法。方法　自 1985～ 2 0 0 0年间应用脾大部切除将残脾与肺底固定术治疗门脉高压症患者 2 80例 ,通过X线、B型超声、锝扫描、血清Tuftsin检测、残脾病理检查 ,观察胸腔残脾形态及功能变化 ,采用血管造影、DSA等检测方法 ,了解脾肺间分流情况。结果　胸腔残脾均存活 ,功能正常。部分病人血清Tuftsin水平术前 (6 0 2± 16 4) μg/L ,术后为 (6 6 5± 144 ) μg/L。血管造影显示门肺形成分流通路。食管钡餐透视证实术后食管静脉曲张改善或消失 ,术后随访再出血率为 3% ,肝功能改善 ,腹水消失。无肝性脑病及OPSI发生。结论　保留脾极性脾大部切除术是门脉高压症巨脾保脾术最理想的术式。脾大部切除脾肺固定术可作为治疗门脉高压症的一种术式 。Objective To study the effect of subtotal splenectomy and splenopulmopexy in the treatment of portal hypertension and search a novel surgical procedure for portal hypertension.Methods Two hundred and eighty patients with portal hypertension were treated by subtotal splenectomy and splenopulmopexy from 1985 to 2000.The changes in the morphology and function of residual spleen in thorax were observed by X ray, B ultrasonic examination, 99m Tc sulfur collid scan, the examination of serum Tuftsin level and the pathological biopsy.The blood vessel radiograph and DSA were carried out to observe the condition of splenopulmonic shunt.Results The residual spleen was survived and functioned normally in thorax.Preoperative serum Tuftsin level was (60±164) and the postoperative was (665±144) μg/L.The passage way of shunt was established between portal venous system and lung.The esophageal varicosity was improved or disappeared.The rate of re bleeding was 3% after operation.The liver function was improved and the ascites disappeared.No hepatic encephalopathy and OPSI occurred postoperatively.Conclusion Splenopole preserving subtotal splenectomy is the most perfect operation in all kinds of operations on giant spleen of portal hypertension.Subtotal splenectomy and splenopulmopexy may become a new operation on portal hypertension.The splenectomy of preserving partial spleen is more valuable on portal hypertension than on splenic trauma.

关 键 词：脾大部切除术 门脉高压症 脾肺固定术 

分 类 号：R657.34[医药卫生—外科学]