改良脾大部切除的联合手术治疗肝硬化门静脉高压症的疗效  

Therapeutic effects of improved large part spleen excision in the treatment of cirrhosis-induced hypertension syndrome

作　　者：曹秀峰[1] 杨洪湘[1] 杨树成[1] 吴必超[1] 王山[1] 张成阳[1] 黄志华[1] 

机构地区：[1]南京医科大学第三临床医院肿瘤中心

出　　处：《腹部外科》2001年第4期204-206,共3页Journal of Abdominal Surgery

摘　　要：目的　为探讨改良脾大部分切除的联合手术治疗肝炎后肝硬变门静脉高压的疗效。方法　将同期收治的肝炎后肝硬变病人随机分成甲、乙两组 ,每组 30例。甲组行保留脾下极血管的脾大部切除 ,残脾用大网膜包裹后与腹膜固定 ,加保留胃迷走神经干的断流术。乙组作全脾切除加断流术。结果　甲、乙组两种术式分别有统计学意义的降低了自由门静脉压力 0 .72kPa和 0 .85kPa。全部病人随访 5～ 10年 ,甲组病人DSA证实残脾与后腹膜形成了丰富的分流通路 ,乙组有 5例反复呕血。两组的 5年生存率分别为 93.33%和 83.33% (P <0 .0 5 ) ,甲组病人无腹泻、肠鸣 ,乙组发生 11例。结论　改良脾大部切除的联合手术既降低了门静脉压力又保留了脾脏的功能 ,并可防止术后再呕血 ,提高了 5年生存率和生活质量。Objective To evaluate the therapeutic effects of improved large part spleen excision in the treatment of cirrhosis induced hypertension syndrome. Methods The in patients at the same time were randomly divided into two groups ( n =30 in each group).In the group A, large part of spleen was resected with preservation of the lower vessels of residual spleen.The residual spleen was wrapped with omentum and fixed with peritoneum.Devascularization of portal hypertension was performed and vagal trunk was kept.In the group B, total spleenectomy was performed with devascularization of portal hypertension.Results In both group A and group B, the free portal pressure was decreased by 0.72 kPa and 0.85 kPa respectively.All the patients were followed up 5 to 10 years.In the group A, rich shunt was found between residual spleen and posterior peritoneum by DSA.In the group B, 5 patients spit blood repeatedly.The 5 year survival rate was 93.33% and 83.33% respectively in group A and group B ( P < 0.05 ).There was no diarrhea in the group A, while in group B 11 patients with diarrhea.Conclusion Improved large part spleen excision not only reduces the portal pressure and kept the function of spleen, but also prevent s post operative haematemesis again, which increases 5 year survival rate and improves life quality.

关 键 词：脾大部切除术 肝硬化 门脉高压症 疗效 

分 类 号：R657.31[医药卫生—外科学] R657.34[医药卫生—临床医学]