选择性脾胃区减断术与脾切除联合贲门周围血管离断术治疗肝硬化并发门静脉高压症患者疗效对照研究  

A comparative study of selective decongestive devascularization of gastrosplenic region and splenectomy and pericardial devascularization combination in the treatment of patients with cirrhotic portal hypertension

作　　者：何晓非[1] 陈杰[1] 赵斌[1] 陆世峰 He Xiaofei;Chen Jie;Zhao Bin(Department of Hepatobiliary Surgery,Fourth People's Hospital,Zigong 643000,Sichuan Province,China)

机构地区：[1]四川省自贡市第四人民医院肝胆外科,643000 [2]广西中医药大学第一附属医院肝胆外科

出　　处：《实用肝脏病杂志》2025年第2期238-241,共4页Journal of Practical Hepatology

基　　金：四川省自贡市科技局重点科技研究计划项目(编号:2020YLSF07)。

摘　　要：目的比较研究选择性脾胃区减断术(SDD-GSR)与脾切除联合贲门周围血管离断术(SPD)治疗肝硬化并发门静脉高压症(PHT)患者的效果差异。方法2019年1月~2024年1月我院收治的65例PHT患者,其中32例观察组接受SDD-GSR治疗,33例对照组接受SPD治疗。采用玻璃管水柱测压计检测胃网膜右静脉门静脉压力;使用超声诊断仪检测门静脉血流量(PVF)、门静脉直径(PVD)和门静脉血流流速(PVV);使用流式细胞仪检测外周血T淋巴细胞亚群。结果在治疗结束后,观察组门脉压力为(21.1±4.2)cmH_(2)O,显著低于对照组【(25.7±5.3)cmH_(2)O,P<0.05】;在手术后3个月,观察组PVD为(1.3±0.3)cm,显著小于对照组【(1.5±0.4)cm,P<0.05】,而PVV为(47.7±3.5)cm/s,显著快于对照组【(41.0±3.1)cm/s,P<0.05】;手术前后,两组血清肝功能指标和外周血血细胞计数比较,差异无统计学意义(P>0.05);在治疗后3个月,观察组外周血CD4^(+)细胞百分比和CD4^(+)/CD8^(+)比值分别为(41.9±3.4)%和(1.4±0.3),显著高于对照组【分别为(35.6±3.1)%和(1.2±0.2),P<0.05】。结论作为新兴的手术,采取SDD-GSR治疗肝硬化并发PHT患者近期疗效好,在改善门静脉血流动力学和免疫功能指标方面可能具有更好的优势,值得进一步探讨。Objective The aim of this study was to compare efficacy selective decongestive devascularization of gastrosplenic region(SDD-GSR)and splenectomy and pericardial devascularization(SPD)combination in the treatment of cirrhotics with portal hypertension(PHT).Methods Sixty-five patients with cirrhotic PHT were encountered in our hospital between January 2019 and January 2024,and out of them,32 patients in observation group received SDD-GSR and 33 in control received SPD.Portal vein pressure was measured by glass water column manometer through right gastroepiploic vein.Portal vein flow(PVF),portal vein diameter(PVD)and portal vein velocity(PVV)were determined by color Doppler ultrasound.Peripheral blood T lymphocyte subsets were detected by flow cytometry.Results By end of surgery,the portal vein pressure in the observation group was(21.1±4.2)cmH_(2)O,much lower than[(25.7±5.3)cmH_(2)O,P<0.05]in the control group;by end of three months after operation,the PVD in the observation was(1.3±0.3)cm,much smaller than[(1.5±0.4)cm,P<0.05],while the PVV was(47.7±3.5)cm/s,much quicker than[(41.0±3.1)cm/s,P<0.05]in the control;before and after operation,there were no significant differences as respect to liver function tests and blood cell counts between the two groups(P>0.05);by three months after operation,percentage of peripheral blood CD4^(+)cells and CD4^(+)/CD8^(+)cell ration in the observation group were(41.9±3.4)% and(1.4±0.3),both significantly higher than[(35.6±3.1)%and(1.2±0.2),respectively,P<0.05]in the control group.Conclusion The SDD-GSR operation has a satisfactory efficacy in the treatment of cirrhotic PTH,with improvement of portal vein hemodynamics and immune functions,which warrants further clinical investigation.

关 键 词：肝硬化 门静脉高压症 选择性脾胃区减断术 脾切除联合贲门周围血管离断术 治疗 

分 类 号：R657.3[医药卫生—外科学]