肝豆状核变性合并脾功能亢进患者脾切除临床观察  

Clinical observation of splenectomy in hepatolenticular degeneration combined with hypersplenism

作　　者：王振[1,2] 冯辉 于庆生 潘晋方[1,2] 沈毅 彭辉[1,2] WANG Zhen;FENG Hui;YU Qingsheng;PAN Jinfang;SHEN Yi;PENG Hui(Department of General Surgery,The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,China;不详)

机构地区：[1]安徽中医药大学第一附属医院普外科,合肥230031 [2]安徽中医药科学院外科研究所

出　　处：《山东医药》2022年第26期25-29,共5页Shandong Medical Journal

基　　金：十二五国家临床重点专科项目门静脉高压和脾脏专项(财社2013-239号)。

摘　　要：目的探讨肝豆状核变性(HLD)合并脾功能亢进的成人患者行单纯脾切除的效益和风险。方法收集100例肝硬化合并脾功能亢进的成人患者,将其分为HLD组50例和乙型病毒性肝炎(HBV)组50例。两组均接受单纯脾切除手术,记录两组手术时间、术中出血量和术后引流量,监测术中平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2);于术前1天及术后第1、7、14天采集空腹静脉血,使用全自动血细胞分析仪检测白细胞(WBC)、红细胞(RBC)、血小板(PLT)和血红蛋白(Hb),使用全自动生化分析仪检测肝功能指标天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)和白蛋白(ALB);观察术后并发症(包括腹腔出血、门静脉系统血栓、PVST、切口并发症、肺部感染和泌尿系感染)的发生情况,计算出院时的病死率。结果两组手术时间、术中出血量和术后引流量以及术中不同时间点的MAP、HR、SPO2比较,差异均无统计学意义(P均>0.05)。两组术后WBC均较术前升高,术后第1天达到最高点,术后第7、14天逐渐下降至正常范围(P均<0.05);两组术后RBC、Hb、PLT均高于术前,且术后第7、14天高于术后第1天,术后第14天高于第7天(P均<0.05)。两组术后第1天ALT、AST、TBIL较术前升高,术后第7天降至术前水平,第14天继续降低;术后第1天ALB较术前降低,术后第7天升高至术前水平,术后第14天继续升高(P均<0.05)。HBV组6例、HLD组9例出现手术并发症,并发症分级均为Ⅰ级,两组并发症发生率比较差异无统计学意义(P>0.05)。两组均无死亡病例。结论HLD合并脾功能亢进行脾切除不仅解决了患者长期的脾功能亢进状态,同时术后肝功能也得到明显改善;与其他疾病引起的脾功能亢进行脾切除患者比较,术中生命体征平稳,术后并发症和病死率无增加。Objective To investigate the benefits and risks of splenectomy in adult patients with hepatolenticular de⁃generation(HLD)and hypersplenism.Methods A total of 100 adult patients with liver cirrhosis and hypersplenism were collected and were divided into the HLD group of 50 cases and the viral hepatitis B(HBV)group of 50 cases.Pa⁃tients in both groups received splenectomy,and the operation time,intraoperative blood loss and postoperative drainage volume were recorded,and intraoperative MAP,HR,and SPO2 were monitored.Fasting venous blood was collected at 1 day before surgery and 1,7,and 14 days after surgery.We used an automatic blood cell analyzer to detect WBC,RBC,PLT and Hb,and used automatic biochemical analyzer to detect liver function indexes AST,ALT,TBIL and ALB.The in⁃cidence of postoperative complications(including intraabdominal hemorrhage,pancreatic leakage,portal vein system thrombosis(PVST),incision complications,pulmonary infection and urinary tract infection)were observed,and the mor⁃tality rate at discharge was calculated.Results There were no significant differences in operation time,intraoperative blood loss,postoperative drainage,MAP,HR,or SPO2 at different time points during the operation between the two groups(all P>0.05).The postoperative WBC in both groups was higher than that before operation,reaching the highest point on the 1st day after operation,and gradually decreased to the normal range on the 7th and 14th days after operation(all P<0.05);postoperative RBC,Hb,and PLT in both groups were higher than those before surgery,and those on the 7th and 14th days after surgery were higher than those on the 1st day after surgery,and those on the 14th day after surgery were higher than those on the 7th day after surgery(all P<0.05).The levels of ALT,AST and TBIL in the two groups in⁃creased on the 1st day after operation in comparison with those before operation,decreased to the preoperative level on the 7th day after operation,and continued to decrease on the 14th day;on the 1st day afte

关 键 词：肝豆状核变性 脾功能亢进 脾切除 

分 类 号：R657.6[医药卫生—外科学]