保脾断流术与切脾断流术治疗胃底食管曲张静脉破裂出血的疗效及安全性分析  

Therapeutic effect and safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage

作　　者：朱卫华[1] 刘以俊[1] 张哲栋 谢文勇[1] 张大方[1] 李澍[1] 朱继业[1] 冷希圣[1] Zhu Weihua;Liu Yijun;Zhang Zhedong;Xie Wenyong;Zhang Dafang;Li Shu;Zhu Jiye;Leng Xisheng(Department of Hepatobiliary Surgery,Perking University People＇s Hospital,Bering 100044,China)

机构地区：[1]北京大学人民医院肝胆外科,100044

出　　处：《中华普通外科杂志》2018年第7期540-543,共4页Chinese Journal of General Surgery

摘　　要：目的比较保留脾脏和切除脾脏的贲门周围血管离断手术治疗胃底食管曲张静脉破裂出血的疗效及安全性。方法回顾性分析北京大学人民医院2009--2015年行贲门周围血管离断术的70例患者，其中29例行保脾断流术，41例行切脾断流术。结果保脾组的术后门静脉压力下降约14％，切脾组下降约23％，差异有统计学意义（t=2．87，P=0．01）。保脾组平均出血量为（829±720）ml，切脾组为（1400±1329）ml，差异有统计学意义（t=2．311，P=0．024）。术后1周，切脾组的外周血PLT和WBC均高于保脾组（t=-5．379、-4．924．均P〈0．01）。保脾组术后总体并发症的发生率为24％，切脾组为39％。保脾组术后1周门静脉血栓的发生率为10％，切脾组为31％，差异有统计学意义（r=0．036，P〈0．05）。保脾组的1年再出血率为4％，3年再出血率为8％，切脾组的1年再出血率为4％，3年再出血率为8％，两组相比差异均无统计学意义（均P〉0．05）。结论对于药物或内镜治疗无效的门静脉高压胃底食管曲张静脉破裂出血的患者，保脾断流术与切脾断流术相比术中出血量更少，术后门静脉血栓发生率更低，近期和远期止血效果理想。Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage. Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed. 29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy. Results Postoperative portal pressure in spleen-preserving group decreased 14% , that in splenectomy group decreased 23% （ t = 2. 87, P = 0. 01 ）. The average blood loss in without splenectomy group was （ 829 ±720 ） ml in contrast to （ 1 400±1 329 ） ml in splenectomy group （ t = 2. 311, P = 0. 024 ）. Postoperative WBC and platelet count in without splenectomy group were lower （ t = - 5. 379, t = - 4. 924, all P 〈 0. 01 ）. The postoperative complication rate （ 24% vs. 39% ） , and portal venous thrombosis （10% vs. 31% ） were all in favour of splenectomy free group （Х^2 = 0. 036, P 〈0. 05）. The 1- and 3-year＇s recurrent bleeding rate were 4% and 8% compared with 4% and 8% （all P 〉 0. 05 ）. Conclusion Paraesophagogastric devascularization without spleneetomy has less blood loss during the surgery, lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.

关 键 词：高血压 门静脉 食管和胃静脉曲张 脾切除术 贲门周围血管离断术 

分 类 号：R657.31[医药卫生—外科学]