全脾切除术与部分脾切除术对门静脉高压症脾功能亢进患者免疫功能影响的比较  

Comparison of effects on immune function of patients with portal hypertension and hypersplenism between total splenectomy and partial splenectomy

作　　者：王永军[1] 罗大勇[1] 李恒[1] 张伟 秦一雨[2] 罗志梅 

机构地区：[1]安徽省阜阳市第二人民医院普通外科,236015 [2]江苏省盐城卫生职业技术学院科技处,224005

出　　处：《中华肝脏外科手术学电子杂志》2017年第3期216-221,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：中国肝炎防治基金会王宝恩肝纤维化研究基金(XJS201311)

摘　　要：目的探讨全脾切除术与部分脾切除术对肝硬化合并门静脉高压症脾功能亢进(脾亢)患者免疫功能的影响。方法回顾性分析2012年9月至2015年10月安徽省阜阳市第二人民医院收治的142例肝硬化合并门静脉高压症脾亢患者临床资料。其中男96例,女46例;年龄35~68岁,中位年龄53岁。患者均签署知情同意书,符合医学伦理学规定。根据术式不同将患者分为贲门周围血管离断术+全脾切除术组(全脾切除术组,85例)和贲门周围血管离断术+部分脾切除术(部分脾切除术组,57例)。两组患者围手术期指标比较采用t检验,术后并发症发生率比较采用χ~2检验。结果术后2个月全脾切除术组IL-1、IL-2、IL-6、TGF-β、TNF-α水平分别为(37.3±2.5)、(35.5±1.0)、(47.7±2.6)、(54.6±1.2)、(25.3±1.1)μg/L,明显低于部分脾切除术组的(45.2±0.7)、(47.7±2.3)、(57.9±5.6)、(67.6±1.2)、(31.5±1.6)μg/L,而IgM水平(2.15±0.04)g/L明显高于部分脾切除术组的(1.86±0.03)g/L(t=-7.65,-7.63,-7.78,-10.12,-8.34,3.55;P<0.05)。部分脾切除术组上消化道出血及腹腔内出血发生率为25%(14/57),明显高于全脾切除术组的8%(7/85)(χ~2=7.541,P<0.05)。结论对于肝硬化合并门静脉高压症脾亢患者,与部分脾切除术相比,全脾切除术后患者机体免疫功能可能恢复更快,其技术更为安全、成熟、有效。Objective To compare the effects on the immune function of patients with liver cirrhosis complicated with portal hypertension and hypersplenism between total splenectomy and partial splenectomy. Methods Clinical data of 142 patients with liver cirrhosis complicated with portal hypertension and hypersplenism who were admitted to the Second People＇s Hospital of Fuyang between September 2012 and October 2015 were retrospectively analyzed. Among them, 96 cases were males and 46 females, aged 35-68 years old with a median age of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the surgical procedures,the patients were divided the pericardial devaseularization ＋ total splenectomy group （total splenectomy group, n=85） and pericardial devascularization ＋ partial splenectomy group （partial splenectomy group, n=57）. The perioperative indexes between two groups were compared using t test. The incidence of postoperative complications was compared using Chi-square test. Results The IL-1, IL-2, IL-6, TGF-13 and TNF-α level at postoperative 2 months in the total splenectomy group was respectively （37.3±2.5）, （35.5±1.0）, （47.7±2.6）, （54.6±1.2） and （25.3±1.1） μg/L, significantly lower than （45.2±0.7）, （47.7±2.3）, （57.9±5.6）, （67.9±1.2） and （31.5±1.6） μg/L in the partial splenectomy group, whereas the IgM level was （2.15±0.04） g/L in the total splenectomy group, significantly higher than （1.86±0.03） g/L in the partial splenectomy group （t=-7.65, -7.63, -7.78, -10.12, -8.34, 3.55; P〈0.05）. The incidence of upper gastrointestinal and intraperitoneal hemorrhage in the partial splenectomy group was 25% （14/57）, significantly higher than 8% （7/85） in the total splenectomy group （X^2=7.541, P〈0.05）. Conclusions For the patients with liver cirrhosis complicated with portal hypertension and hypersplenism, the immune function of the patients with total splenect

关 键 词：高血压 门静脉 脾功能亢进 脾切除术 脾部分切除术 免疫系统 

分 类 号：R657.6[医药卫生—外科学]