选择性脾胃区减断术治疗肝硬化门静脉高压症的临床价值分析  

A comparative study of selective decongestive devascularization of gastrosplenic region and hassab devascularization in the treatment of patients with portal hypertension

作　　者：段建文[1] 余华军[2] 叶海林[3] 陈永胜[4] 张启瑜[5] Duan Jianwen;Yu Huajun;Ye Hailin;Chen Yongsheng;Zhang Qiyu(Department of General Surgery,Quzhou Hospital Affiliated to Wenzhou Medical University(Quzhou People's Hospital),Quzhou 324000,Zhejiang Province,China;Department of Pancreatitis Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325035,China;Department of Hepatobiliary Surgery,Lishui People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Hepatobiliary Surgery,Zhejiang Quhua Hospital,Quzhou 324000,Zhejiang Province,China;Department of Hepatobiliary-Pancreatic Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)普通外科,浙江衢州324000 [2]温州医科大学附属第一医院胰腺炎中心,温州325035 [3]丽水市人民医院肝胆外科,浙江丽水323000 [4]浙江衢化医院肝胆外科,浙江衢州324000 [5]温州医科大学附属第一医院肝胆胰外科,温州325035

出　　处：《中华肝胆外科杂志》2021年第7期525-528,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省衢州市科技计划指导性项目(2019-106)。

摘　　要：目的比较选择性脾胃区减断术(SDD-GSR)与脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的临床疗效。方法回顾分析温州医科大学附属第一医院收治的134例肝硬化门静脉高压症患者资料,男性102例,女性32例,平均年龄51岁。其中61例行SDD-GSR纳入SDD-GSR组,73例行脾切除联合贲门周围血管离断术纳入对照组。比较两组手术时间、术中出血量、自由门静脉压力(FPP)、肝功能Child-Pugh分级、术前和术后白细胞计数与血小板计数、术后并发症等。结果SDD-GSR组手术时间165(110,198)min、术中出血量280(100,650)ml,少于对照组190(135,605)min、895(300,3500)ml,差异有统计学意义(均P<0.05)。术后SDD-GSR组和对照组FPP分别为39(35,44)cmH2O(1 cmH2O=0.098 kPa)和38(34,44)cmH2O,均低于本组术前,差异有统计学意义(均P<0.05)。SDD-GSR组术后血小板计数与白细胞计数均低于同期对照组水平,差异有统计学意义(均P<0.05)。SDD-GSR组患者术后近期肝功能Child-Pugh分级优于对照组,差异有统计学意义(P<0.05)。SDD-GSR组腹腔感染、门静脉系统血栓发生率低于对照组,差异有统计学意义(均P<0.05)。结论与脾切除联合贲门周围血管离断术相比,SDD-GSR具有术中出血少,肝功能改善明显,并发症少的优点,是治疗肝硬化门静脉高压症的一种有效术式。Objective To determine the clinical efficacy of selective decongestive devascularization of gastrosplenic(SDD-GSR)and splenectomy combined with pericardial vascularization in the treatment of portal hypertension in cirrhosis.Methods A total of 134 patients with cirrhosis portal hypertension admitted to the First Affiliated Hospital of Wenzhou Medical University were enrolled in the study,including 102 males and 32 females,with an average age of 51 years.Of 61 cases of SDD-GSR were included in the SDD-GSR group,and 73 cases of splenectomy combined with pericardial vascularization were included in the control group.Preoperative and postoperative white blood cell count,platelet count,Child-Pugh grade of liver function,free portal pressure(FPP)and postoperation tomplication were analyzed in the two groups.Operation time,intraoperative blood loss,free portal pressure(FPP),Child-Pugh grade of liver function,preoperative and postoperative white blood cell count,platelet count,and postoperative complications were analyzedin the two groups.Results The operation time and intraoperative blood loss of SDD-GSR group were 165(110,198)min and 280(100,650)ml,which were lower than those of control group[190(135,605)min and 895(300,3500)ml],the differences were statistically significant(P<0.05).Postoperative FPP of SDD-GSR group and control group was 39(35,44)cmH2O(1 cmH2O=0.098 kPa)and 38(34,44)cmH2O,respectively,which were lower than those before operation,with statistical significance(both P<0.05).Postoperative platelet count and white blood cell count in SDD-GSR group were lower than those in control group,and the differences were statistically significant(all P<0.05).The Child-Pugh grading of recent postoperative liver function in SDD-GSR group was better than that in control group,with statistical significance(P<0.05).The complication rate(abdominal infection and portal vein thrombosis)of control group was higher than SDD-GSR group.Conclusion SDD-GSR is better than splenectomy combined with pericardial vascularization since

关 键 词：肝硬化 高血压 门静脉 断流术 脾切除术 

分 类 号：R657.3[医药卫生—外科学]