腹腔镜脾切除联合断流术对肝脏合成功能和肝纤维化程度影响的前瞻性研究  

A prospective study of the effect of laparoscopic splenectomy and azygoportal disconnection on liver synthetic function and liver cirrhosis

作　　者：肖坤清 高添铭 蔡金红 史招宝 金圣杰[3] 张弛[3] 周保换 柏斗胜[3] 蒋国庆[3] Xiao Kunqing;Gao Tianming;Cai Jinhong;Shi Zhaobao;Jin Shengjie;Zhang Chi;Zhou Baohuan;Bai Dousheng;Jiang Guoqing(Department of Hepatobiliary Surgery,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Department of Hepatobiliary Surgery,Yangzhou School of Clinical Medicine of Dalian Medical University,Yangzhou 225001,China;Department of Hepatobiliary Surgery,Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院肝胆外科,扬州225001 [2]大连医科大学扬州临床医学院肝胆外科,扬州225001 [3]江苏省苏北人民医院肝胆外科,扬州225001

出　　处：《中华外科杂志》2025年第1期51-57,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(82173353);江苏省卫生健康委员会科研项目(K2023002)。

摘　　要：目的探讨腹腔镜脾切除联合断流术(LSD)对肝脏合成功能和肝纤维化程度的影响。方法本研究为前瞻性病例系列研究。纳入2014年9月至2016年1月扬州大学附属苏北人民医院肝胆外科连续收治的接受了LSD的肝硬化合并门静脉高压患者的围手术期和随访资料。收集患者的门静脉直径、门静脉血流速度、血常规、肝功能、肝合成蛋白[抗凝血酶Ⅲ(AT-Ⅲ)、蛋白S、蛋白C]、肝硬化四项(Ⅳ型胶原、Ⅲ型前胶原、层粘连蛋白、透明质酸)等临床数据。多组间比较采用重复测量方差分析,事后多重比较采用最小显著性差异法。结果研究共纳入106例患者,其中男性70例,女性36例,年龄(51.8±9.8)岁(范围:28~75岁)。术后门静脉直径和门静脉血流速度均较术前有下降趋势(F值分别为14.03、12.15,P值均<0.01),总胆红素、白蛋白、凝血酶原时间、国际标准化比值、Child-Pugh评分和分级有所改善(F值分别为17.96、56.01、66.63、35.83、33.49和27.50,P值均<0.01),AT-Ⅲ、蛋白S、蛋白C、Ⅳ型胶原、Ⅲ型前胶原、层粘连蛋白和透明质酸水平亦有改善(F值分别为47.87、36.26、18.02、22.79、14.58、44.35和14.38,P值均<0.01)。与术前相比,术后第1周至术后第24个月门静脉直径有所降低(t=5.45~9.39,P值均<0.01)。与术前相比,术后第1周至术后第24个月门静脉血流速度有所降低(t=4.02~8.43,P值均<0.01)。与术前相比,术后第24个月血常规(白细胞计数、血红蛋白、血小板计数)、肝功能(总胆红素、白蛋白、凝血酶原时间、国际标准化比值、Child-Pugh评分)、肝合成蛋白(AT-Ⅲ、蛋白S、蛋白C)、肝硬化四项(Ⅳ型胶原、Ⅲ型前胶原、层粘连蛋白、透明质酸)等均得到不同程度的改善(t=-20.46~11.93,P值均<0.01)。结论初步研究结果显示,LSD可降低肝硬化门静脉高压患者的门静脉压力、恢复血细胞数量,并改善其肝脏合成功能和肝纤维化程度。ObjectiveTo investigate the effect of laparoscopic splenectomy and azygoportal disconnection(LSD)on liver synthesis and development of liver cirrhosis.MethodsThis is a prospective case series study.The clinical data of liver cirrhotic patients with portal hypertension who received LSD at the Department of Hepatobiliary Surgery of Northern Jiangsu People′s Hospital Affiliated to Yangzhou University from September 2014 to January 2016 were included.This study analyzed the diameter of the portal vein,the velocity of portal blood flow,the routine blood parameters,the liver function,the synthetic proteins of liver(antithrombinⅢ(AT-Ⅲ),protein S,protein C),and the serum content of liver fibrotic markers(collagen typeⅣ,procollagen typeⅢ,laminin,hyaluronidase).Repeated measures ANOVA was used for comparison between multiple groups,and least significance difference was used for post-hoc multiple comparison.ResultsA total of 106 patients were included in the study,including 70 males and 36 females,aged(51.8±9.8)years(range:28 to 75 years).Compared with the preoperative results,the diameter of portal vein and the velocity of portal vein decreased after surgery(F=14.03,12.15,respectively,both P<0.01).Compared with the preoperative results,the total bilirubin,albumin,prothrombin time,international normalized ratio,Child-Pugh score and classification were improved(F=17.96,56.01,66.63,35.83,33.49,and 27.50,respectively,all P<0.01),and the AT-Ⅲ,protein S,protein C,collagen typeⅣ,procollagen typeⅢ,laminin and hyaluronidase levels were also improved(F=47.87,36.26,18.02,22.79,14.58,44.35,and 14.38,respectively,all P<0.01).Compared with the preoperative period,the diameter of portal vein was reduced from the first week to the 24 th month after surgery(t=5.45 to 9.39,all P<0.01).Compared with the preoperative period,the velocity of portal vein blood from the first week after surgery to the 24 th month after surgery was decreased(t=4.02 to 8.43,all P<0.01).Compared with the preoperative period,routine blood parameters(

关 键 词：肝硬化 高血压 门静脉 腹腔镜 脾切除术 断流术 

分 类 号：R73[医药卫生—肿瘤]