脾切除联合门奇静脉断流术治疗乙型肝炎肝硬化门脉高压症患者疗效研究  

Re-observation of splenectomy and esophagogastric devascularization in patients with hepatitis B cirrhosis and portal hypertension

作　　者：刘公伟 吴雪 唐聃 敖宇 陈景祥 蔡治方 Liu Gongwei;Wu Xue;Tang Dan(Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital,Zunyi Medical University,Zunyi 563000,Guizhou Province,China)

机构地区：[1]遵义医科大学第二附属医院肝胆胰外科,贵州省遵义市563000 [2]遵义医科大学第二附属医院手术室,贵州省遵义市563000

出　　处：《实用肝脏病杂志》2021年第5期649-652,共4页Journal of Practical Hepatology

基　　金：贵州省自然科学基金资助项目(编号:2019121)。

摘　　要：目的探讨采用脾切除(SPL)联合门奇静脉断流术(PAD)治疗乙型肝炎肝硬化门脉高压症患者的临床疗效。方法2017年2月~2019年11月我院诊治的87例乙型肝炎肝硬化门脉高压症患者,其中45例接受SPL联合PAD治疗(观察组),另42例接受胃底曲张静脉栓塞术和部分脾栓塞术(对照组)。测量上臂围和三头肌皮褶厚度,使用多普勒超声诊断仪检测门静脉血流量(PVF)、肠系膜上静脉血流量(SMVF)和脾静脉血流量(SVF)。结果术后,观察组BMI、上臂围和三头肌皮褶厚度分别为(21.5±1.3)kg/m^(2)、(22.1±1.0)cm和(10.3±1.0)mm,与对照组【分别为(21.2±1.2)kg/m^(2)、(22.2±1.2)cm和(10.1±1.1)mm,P>0.05】比,无显著性差异;术后1个月,观察组PVF和SMVF分别为(670.9±46.2)ml/min和(583.5±69.0)ml/min,与对照组【分别为(695.7±50.2)ml/min和(540.2±68.4)ml/min,P<0.05】比,差异显著;观察组血清ALB水平为(34.0±1.4)g/L,显著高于对照组【(31.2±1.5)g/L,P<0.05】;观察组并发症发生率为8.9%,显著低于对照组的38.1%(P<0.05)。结论经典的脾切除联合门奇静脉断流术治疗乙肝肝硬化门脉高压症患者有效,降低了门脉压力,改善了肝脏血流灌注和肝功能,提高了营养状态。Objective The aim of this study was to re-observe the clinical efficacy of splenectomy(SPL)and portalazygous disconnection(PAD)in treating patients with hepatitis B cirrhosis and portal hypertension.Methods A total of 87 patients with hepatitis B cirrhosis and portal hypertension were enrolled in our hospital between Februar y 2017 and November 2019,and 45 patients out of them received SPL and esophagogastric devascularization(observation group)and 42 patients underwent percutaneous transhepatic variceal embolization(PTVE)and partial splenic embolization.The body mass index(BMI),mid-upper arm circumference(MUAC)and riceps skinfold thickness(RST)were measured.The portal venous flow(PVF),superior mesenteric venous flow(SMVF)and splenic venous flow(SVF)were measured by sonography.Results One month after operation,the BMI,MUAC and RST in the observation were(21.5±1.3)kg/m^(2),(22.1±1.0)cm and(10.3±1.0)mm,not significantly different as compared to[(21.2±1.2)kg/m^(2),(22.2±1.2)cm and(10.1±1.1)mm,respectively,P>0.05]in the control;the PVF and SMVF were(670.9±46.2)ml/min and(583.5±69.0)ml/min,significantly different compared to[(695.7±50.2)ml/min and(540.2±68.4)ml/min,respectively,P<0.05]in the control;serum albumin levels was(34.0±1.4)g/L,significantly higher than[(31.2±1.5)g/L,P<0.05]in the control;the incidence of post-operational complications was 8.9%,much lower than 38.1%(P<0.05)in the control.Conclusion The classic splenectomy and esophagogastric devascularization combination is still an important choice of treatment for patients with hepatitis B cirrhosis and portal hypertension,which might reduce the portal pressure,improve liver function and liver blood perfusion with fewer complications.

关 键 词：肝硬化 门脉高压症 脾切除术 门奇静脉断流术 治疗 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]