肝储备功能分级法在门静脉高压症脾切除断流术风险评估中的意义  

Hepatic reserve function grading used in risk assessment of splenectomy and pericardial devascularization for portal hypertension patients

作　　者：蒋安[1,2] 张健 陈怡萌[3] 秦博文 周蕊 任松 王宝太[1,2] 杨正安 李宗芳[1,2,4] JIANG An;ZHANG Jian;CHEN Yimeng;QIN Bowen;ZHOU Rui;REN Song;WANG Baotai;YANG Zheng’an;LI Zongfang(Department of General Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;Shanxi Provincial Clinical Medical Research Center for Liver and Spleen Diseases, Xi’an 710004, China;Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021, China;National Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Xi’an 710004, China)

机构地区：[1]西安交通大学第二附属医院普通外科,陕西西安710004 [2]陕西省肝脾疾病临床医学研究中心,陕西西安710004 [3]中国医学科学院肿瘤医院,北京10002 [4]生物诊断治疗国家地方联合工程研究中心,陕西西安710004

出　　处：《西部医学》2021年第7期1031-1034,1038,共5页Medical Journal of West China

基　　金：国家自然科学基金(81670557);陕西省青年科技新星项目(2014KJXX-31)。

摘　　要：目的探讨肝储备功能分级在肝硬化门静脉高压症脾切除断流手术风险评估中的应用价值。方法回顾性分析2009年3月~2016年11月在西安交通大学第二附属医院行脾切除排钉阻断法断流术的47例肝硬化门静脉高压症患者的临床资料。根据术前吲哚菁绿15 min滞留率(ICG R15),检测结果将患者分为A组(ICG R15<30%)28例,B组(ICG R1530%~50%)14例,C组(ICG R15>50%)5例。采用单因素方差分析比较三组围手术期情况。结果C组较其他两组患者,术后血小板升高不明显,总胆红素、直接胆红素、术后第三天腹腔引流量以及肝昏迷和死亡人数则明显升高(P<0.05)。结论准确评估肝储备功能对评估脾切除断流手术风险和预后有一定意义,其中ICG R15<30%患者手术风险较低;ICG R1530%~50%为中风险;ICG R15>50%或Child C级患者术后容易出现肝功能不全、肝性脑病、腹腔出血等并发症,断流手术风险较高,肝移植可能是更合适的治疗方法。Objective To evaluate the liver reserve function grading in the risk assessment of splenectomy and pericardial devascularization with portal hypertension and liver cirrhosis.Methods A retrospective analysis was made on the clinical data of 47 patients with viral hepatitis cirrhosis and portal hypertension.From March 2009 to November 2016,they underwent splenectomy and pericardia devascularization in the department of hepatobiliary surgery,The Second Affiliated Hospital of Xi'an Jiaotong University.Preoperative indocyanine green retention test was used to divide the patients into Group A(n=28)ICG R15<30%,Group B(n=14)ICG R1530%-50%,Group C(n=5)ICG R15>50%.Univariate analysis of variance(ANOVA)was used to compare the indexes of Child-PUGH grading,blood routine,coagulation series,liver function,peritoneal drainage,and complications post operation.Results The total bilirubin,direct bilirubin,peritoneal drainage volume on the third day post operation,the number of hepatic encephalopathy and death cases were significantly increased in group C compared with the other two groups(P<0.05).Conclusion Accurate preoperative assessment of liver function is important to determine the risk and prognosis of splenectomy.On the basis of child-pugh classification,indocine green liver reserve function could be examined to determine liver reserve function.ICG R15<30%suggested low risk of operation.ICG R1530%-50%is medium risk,and ICG R15>50%or Child grade C is high risk.The high risk group have higher incidence of postoperative complications such as liver dysfunction,hepatic encephalopathy,and abdominal hemorrhage.Liver transplantation was the better choice.

关 键 词：肝储备功能 门静脉高压症 脾功能亢进 手术并发症 

分 类 号：R575.2[医药卫生—消化系统]