基于门脉高压症血流动力学特征的Hassab手术疗效研究  

Efficacy of Hassab operation based upon hemodynamic characteristics in portal hypertension

作　　者：叶德强[1] 曹涌[1] 高华 毛卫 谢能文[1] 邢毅 焦磊明[1] 黄义华[1] 袁航 杜小军 Ye Deqiang;Cao Yong;Gao Hua;Mao Wei;Xie Nengwen;Xing Yi;Jiao Leiming;Huang Yihua;Yuan Hang;Du Xiaojun(Department of General Surgery,The Ninth Hospital of Nanchang,Jiangxi Nanchang 330002,China)

机构地区：[1]南昌市第九医院普外科,江西南昌330002

出　　处：《腹部外科》2024年第1期44-50,共7页Journal of Abdominal Surgery

基　　金：江西省卫生健康委科技计划课题(202311296)。

摘　　要：目的探讨脾切除和贲门周围血管离断术(Hassab手术)是否可以有效提高失代偿期肝硬化病人肝动脉灌注并改善肝功能。方法回顾性收集2020年1月至2022年12月在南昌市第九医院普外科接受Hassab手术的97例乙型肝炎肝硬化门脉高压症并脾功能亢进病人的临床资料,依据脾动脉盗血综合征(splenic artery steal syndrome,SASS)诊断标准分为SASS组(40例)和非SASS组(对照组,57例)。比较两组术前、术中、术后各项指标之间的差异。结果SASS组与对照组间术前和术中各项指标差异均无统计学意义(均P>0.05),两组术后第3天终末期肝病模型评分(model for end-stage liver disease,MELD)差异无统计学意义(P>0.05)。两组术后第7天的MELD评分均明显优于术前(均P<0.05);SASS组术后第7天的MELD评分为3.17±2.96,明显优于对照组的4.68±2.31(P<0.05);SASS组术后第14天的肝固有动脉直径[(4.13±0.33)mm]和肝固有动脉流速[(50.83±3.85)cm/s]均明显优于对照组[(3.85±0.34)mm、(47.55±3.05)cm/s](均P<0.05)。结论Hassab手术可以有效提高失代偿期肝硬化病人肝动脉灌注并改善肝功能,将“肝硬化性SASS”的概念引入临床可以使更多肝硬化门脉高压症和脾功能亢进病人受益。Objective To explore whether or not Hassab operation can effectively improve hepatic artery perfusion and liver function in patients with decompensated cirrhosis.Methods A total of 97 patients with hepatitis B cirrhosis and portal hypertension hypersplenism undergoing Hassab operation were selected and divided into two groups of disease(n=40)and control(n=57)according to the diagnostic criteria of splenic artery steal syndrome(SASS).The inter-group differences in perioperative parameters were compared.Results No significant inter-group differences existed in perioperative parameters(P>0.05)or model for end-stage liver disease(MELD)score at Day 3 post-operation(P>0.05).At Day 7 post-operation,MELD score of SASS group was significantly better than that of control group[(3.17±2.96)vs.(4.68±2.31)];At Day 14 post-operation,the values of hepatic artery diameter/velocity were significantly better in SASS group than those in control group[(4.13±0.33)vs.(3.85±0.34)mm;(50.83±3.85)vs.(47.55±3.05)cm/s](P<0.05).Conclusion Hassab operation can effectively improve hepatic artery perfusion and liver function in patients with decompensated cirrhosis.Introducing the concept of"Cirrhotic SASS"into clinical practices may benefit more patients with cirrhosis,portal hypertension and hypersplenism.

关 键 词：HASSAB手术 肝硬化 门脉高压症 脾动脉盗血综合征 肝动脉 

分 类 号：R657.34[医药卫生—外科学]