门奇断流术后并发胸腔积液12例危险因素分析  

Risk factors for pleural effusion after pericardial devascularization: clinical analysis of 12 cases

作　　者：朱耿隆[1] 陈东[2] 苏永辉[1] 贾英斌[1] 索南仁青[1] 关晓东[1] 洪晓鹏[1] 张百萌[1] 

机构地区：[1]中山大学附属第五医院普外三科,珠海519000 [2]中山大学附属第一医院肝胆外科

出　　处：《中华普通外科学文献（电子版）》2014年第4期33-36,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨门奇断流术后胸腔积液的危险因素及防治措施。方法回顾性分析2008年3月至2012年9月收治的77例行门奇断流术患者的临床资料。结果 7例(7/77,9.1%)术前有行非选择性脾动脉栓塞。70例(70/77,90.9%)采用脾切除+贲门周围血管离断术式,7例(7/77,9.1%)采用改良Sugiura术式。平均住院时间为(16.7±2.2)d,住院期间无一例死亡及行二次手术。门奇断流术后胸腔积液发生12例(15.6%)。单因素分析提示门奇断流术后胸腔积液的发生与术前肝功能、脾脏大小、脾周粘连、手术方式及术前脾动脉栓塞有关,差异有统计学意义(P<0.05);多因素Logistic回归分析提示手术方式、术前脾动脉栓塞是影响胸腔积液发生的独立因素(P<0.05)。结论通过避免术前脾动脉栓塞、选择适当的手术方式并改进手术操作,可有效减少门奇断流术后胸腔积液的发生。Objective To investigate the risk factors for pleural effusion and the corresponding prophylactico-therapeutic measures after pericardial devascularization in patients with portal hypertension. Methods Seventy-seven cases with portal hypertension after hepatitis undergoing pericardial devascularization in the Third Department of General Surgery in the Fifth Affiliated Hospital of Sun Yatsen University from Mar 2008 to Sep 2012 were selected for a retrospective study. Results In these 77 patients, 7 cases（9.1%） accepted nonselective splenic embolism before operation. The types of operation were divided into two groups, 70 cases（90.9%） accepted splenectomy plus pericardial devascularization without esophageal transection, the other 7 cases（9.1%） were given modified Sugiura operation. All patients recovered after operation with an average hospitalization time of （16.7 ± 2.2） days. There was no death or second operation in these 77 cases. Pleural effusion emerged in 12 cases（15.6%） after the operation. By using single factor analysis, the pleural effusion after pericardial devascularization was related to the types of operation, hepatic Child-Pugh classification and nonselective splenic embolism before operation, and to the size of spleen, spleen adhesions around. The difference was statistically significant （P〈0.05）. By using multiple factors logistic regression analysis, the type of operation and the nonselective splenic embolism before operation were the independent factors of pleural effusion （P〈0.05）. Couculsion Through avoiding nonselective splenic embolism before operation, selecting appropriate operation type and improving operational skills, we can reduce the occurrence of pleural effusion after pericardial devascularization.

关 键 词：门奇断流术 SUGIURA术 胸腔积液 

分 类 号：R657.3[医药卫生—外科学]