脾部分切除联合门奇静脉断流术对巨脾患者门静脉血栓形成的预防作用  

Partial splenectomy may prevent portal vein thrombosis after hassab surgery in patients with megalosplenia

作　　者：常伟华[1] 李志伟[1] 张昆[1] 齐瑞兆[1] 赵新[1] Chang Weihua;Li Zhiwei;Zhang Kun;Qi Ruizhao;Zhao Xin(Department of General Surgery,302Hospital of PLA,Belting 100039,China)

机构地区：[1]解放军第302医院普通外科,北京100039

出　　处：《中华肝胆外科杂志》2018年第12期843-847,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨保留脾下极血流的脾部分切除联合门奇静脉断流术治疗门静脉高压症,减少术后门静脉血栓形成风险的作用。方法156例门静脉高压症合并巨脾患者,分为A组(脾部分切除62例)及B组(脾切除94例),观察两组围手术期并发症,术后12个月wBc、PLT水平、残脾体积动态变化,以及不同术式对门静脉系统血栓形成的影响。结果A组患者较B组手术时间延长[(189.0±38.5)比(128.0±36.3)min,P<0.05)],术中出血量A组高于B组[(328.0±68.9)比(294.0±49.1)ml,P<0.05],但失血量及术中输血量、术后感染、肝静脉楔压(HVPG)改变、术后再出血率等指标两组差异无统计学意义(P>0.05)。两组患者术后wBc升高水平存在一致性,均在术后第3天增长到峰值,在术后1周逐步下降至正常;术后PLT升高水平A组较B组峰值出现较晚(2周比1周)且更为平缓,峰值水平更接近正常值(P<0.05)。A组门静脉系统血栓形成率显著低于B组(P<0.05)。A组术后1年内残脾体积无显著改变(P>0.05)。结论肝硬化门静脉高压合并巨脾患者行保留脾下极血流的脾部分切除术可有效预防门静脉系统血栓形成。Objective To study whether portal vein thrombosis can be prevented by partial splenectomy combined with portoazygos devascularization,by preserving the integrity of the blood flow of the inferior splenic vessels.Methods 156 patients with portal hypertension and megalosplenia were divided into two groups.62patients in group A who underwent partial splenectomy and 94patients in group B who underwent total splenectomy.The postoperative complications,levels of WBC and PLT,volumes of residual spleen,hepatic vein pressure gradient (HVPG),and prevalence of portal vein thrombosis between the two groups were compared.Results The surgery time of group A was slightly higher than group B [(189.0±38.5)vs. (128.0±36.3)min,P<0.05].The blood loss of group A was slightly higher than that of group B [(328.0± 68.9)vs.(294.0±49.1)ml,P<0.05].The postoperative infection rate,change in HVPG and rehemorrhage rate between the two groups showed no significant differences (P>0.05).The elevation in Leucocyte after operation of the two groups were the same,peaking on day 3.The platelet count of group A increased more gently than group B (2weeks vs 1week),and its peak was closer to the normal threshold (P<0.05).The thrombosis rate of the portal vein system in group A was significantly lower than group B within l year (P< 0.01).The residual spleen did not enlarge after operation (P>0.05).,Conclusion Subtotal splenectomy combined with pericardial devascularization in patients with portal hypertension and megalosplenia preserved the blood flow of the subsplenic polar vessels and reduced the incidence of portal vein thrombosis.

关 键 词：门静脉高压症 门奇静脉断流术 脾部分切除 门静脉血栓 HASSAB手术 

分 类 号：R657.34[医药卫生—外科学] R657.6[医药卫生—临床医学]