腹腔镜辅助改良Sugiura手术与脾切除断流术对肝硬化门静脉高压症患者肝纤维化和凝血功能及再出血率的影响  

Effects of laparoscopic-assisted modified Sugiura operation and splenectomy on liver fibrosis,coagulation function and rebleeding rate in patients with cirrhotic portal hypertension

作　　者：张勇 何文法 罗剑 张涛 ZHANG Yong;HE Wenfa;LUO Jian;ZHANG Tao(Department of Surgery,the Fifth People's Hospital of Jianli,Jingzhou,Hubei,433300,China;Department of Surgery,Jianli People's Hospital,Jingzhou,Hubei,433300,China)

机构地区：[1]监利市第五人民医院外科,湖北荆州433300 [2]监利市人民医院外科,湖北荆州433300

出　　处：《当代医学》2024年第9期34-38,共5页Contemporary Medicine

摘　　要：目的探讨腹腔镜辅助改良Sugiura手术与脾切除断流术对肝硬化门静脉高压症(PHT)患者肝纤维化、凝血功能及再出血率的影响。方法选取2021年1月至2022年6月监利市第五人民医院收治的85例肝硬化PHT患者作为研究对象,根据手术方式不同分为断流组(n=39)与改良组(n=46)。断流组给予脾切除断流术治疗,改良组给予改良Sugiura手术治疗,比较两组手术情况及住院时间、门静脉血流动力学指标、肝纤维化指标、并发症发生情况及再出血率。结果两组手术时间、术中出血量及住院时间比较差异无统计学意义。术后,两组门静脉内径(Dpv)均短于术前,门静脉血流速度(Vpv)、门静脉血流量(Qpv)均慢于术前,且改良组Dpv短于断流组,Vpv、Qpv均慢于断流组,差异有统计学意义(P<0.05)。术后,两组透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)水平均低于术前,且改良组低于断流组,差异有统计学意义(P<0.05)。术后,两组纤维蛋白原(Fg)水平均高于术前,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均短于术前,且改良组Fg水平高于断流组,PT、APTT均短于断流组,差异有统计学意义(P<0.05)。改良组并发症发生率、再出血率均低于断流组,差异有统计学意义(P<0.05)。结论与脾切除断流术相比,腹腔镜辅助改良Sugiura手术治疗肝硬化PHT治疗效果更佳,可显著改善患者肝功能,延缓肝纤维化进程,降低再出血率,安全性较佳。Objective To investigate the effects of laparoscopic-assisted modified Sugiura operation and splenectomy on liver fibrosis,coagula-tion function and rebleeding rate in patients with cirrhotic portal hypertension(PHT).Methods 85 patients with PHT from cirrhosis admitted to the Fifth People's Hospital of Jianli from January 2021 to June 2022 were selected as the study subjects,and they were divided into the discontinuous flow group(n=39)and the improved group(n=46)according to different surgical methods.The discontinuous flow group was treated with splenecto-my and devascularization,and the improved group was treated with modified Sugiura operation,the operation conditions,hospitalization time,portal vein hemodynamic indexes,liver fibrosis indexes,complications rate and rebleeding rate were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss and hospitalization time between the two groups.After operation,diame-ter of portal vein(Dpv)of the two groups was shorter than that before operation,velocity of blood portal vein(Vpv)and portal vein blood flow(Qpv)were slower than those before operation,and Dpv in the improved group was shorter than that in the discontinuous flow group,Vpv and Qpv were slower than those in the discontinuous flow group,the differences were statistically significant(P<0.05).After operation,the levels of hyal-uronic acid(HA),typeⅢprocollagen(PCⅢ),laminin(LN),typeⅣcollagen(Ⅳ-C)of the two groups were lower than those before operation,and the improved group was lower than the discontinuous flow group,the differences were statistically significant(P<0.05).After operation,fibrino-gen(Fg)level of the two groups was higher than that before operation,and prothrombin time(PT),activated partial thromboplastin time(APTT)were shorter than before operation,and Fg level in the improved group was higher than that in the discontinuous flow group,and PT and APTT were shorter than those in the discontinuous flow group,the differences wer

关 键 词：改良SUGIURA手术 脾切除断流术 肝硬化门静脉高压症 肝纤维化 

分 类 号：R575.2[医药卫生—消化系统]