116例门脉高压症合并脾功能亢进施行脾切除术的安全性分析

发布时间：2018-12-13 11:01

【摘要】：目的肝硬化作为门静脉高压常见的发病原因之一,其所导致的肝功能代偿引起门静脉高压是脾功能亢进的最常见原因。目前关于门静脉高压合并脾功能亢进的治疗途径主要是外科手术。本研究通过收集2013年1月-2014年12月在兰州大学第一医院住院的门静脉高压合并脾功能亢进施行脾切除术的患者为研究对象,探讨门静脉高压合并脾功能亢进施行脾切除同围术期安全性的关联以及脾切除对机体的影响。方法收集2013年1月-2014年12月在兰州大学第一医院住院的门静脉高压合并脾功能亢进施行脾切除术116例患者,依据患者手术指征分别行单纯脾切除术、脾切除+断流术、脾切除+分流术以及脾切除+联合断流分流术,观察患者术前以及术后7天、1个月、3个月、6个月的恢复指标、并发症指标等。结果不同处理组之间性别、吸烟、饮酒、高血压、糖尿病、心脏病、乙肝、丙肝、肝功能A级、B级的比率、年龄、体重、身高、脾脏长径及厚度、血小板、血红蛋白、白细胞、尿素氮、肌酐、总胆红素、谷草转氨酶、谷丙转氨酶、术中胶体液用量均无明显差异(P0.05),在手术出血量、晶体液、输血人数、未输血人数方面、横结肠脾曲和胰尾损伤、手术总时间方面存在差异(P0.05)。术后7天、1个月、3个月不同处理组之间出现左侧胸腔积液、脾窝局限性积液、左膈下积液、切口感染、脾热、胰瘘的比率以及脾窝血性引流量、白蛋白指标均无明显差异(P0.05),而在谷草转氨酶、谷丙转氨酶指标方面存在差异(P0.05)；术后6个月所有观察指标间均无明显差异(P0.05)。吸烟、饮酒、高血压、糖尿病、心脏病对于增加术中风险及术后并发症发生率未有显著影响(P0.05),乙肝、丙肝对于增加术中风险及术后并发症发生率的概率是正常人群的4.21倍和4.33倍。结论门静脉高压症合并脾功能亢进施行脾切除术是安全可行的,且随着医疗技术发展,较以往安全性有所提高,门静脉高压症所引起的上消化道出血应依据不同指征采取不同手术方式；既往乙肝、丙肝是增加术中风险及术后并发症发生率的影响因素。
[Abstract]:Objective as one of the common causes of portal hypertension, liver cirrhosis is the most common cause of hypersplenism. Surgical treatment is the main treatment of portal hypertension with hypersplenism. Patients with portal hypertension combined with hypersplenectomy were collected from January 2013 to December 2014 in the first Hospital of Lanzhou University. To investigate the relationship between splenectomy and perioperative safety of portal hypertension combined with hypersplenism and the effect of splenectomy on body. Methods from January 2013 to December 2014, 116 patients with portal hypertension combined with hypersplenism who were hospitalized in the first Hospital of Lanzhou University were divided into two groups: simple splenectomy and splenectomy. Splenectomy shunt and splenectomy combined with devascularization were observed before and 7 days, 1 month, 3 months and 6 months after operation. Results the sex, smoking, drinking, hypertension, diabetes, heart disease, hepatitis B, hepatitis C, liver function A, B grade, age, weight, height, spleen length and thickness, platelet, hemoglobin, blood platelet, hemoglobin, There was no significant difference in white blood cell, urea nitrogen, creatinine, total bilirubin, glutamic oxaloacetic transaminase, alanine aminotransferase and intraoperative colloidal fluid (P0.05). There was significant difference in the total operation time between splenic curvature of transverse colon and pancreatic tail injury (P0.05). Left pleural effusion, localized effusion in splenic fossa, subphrenic effusion, incision infection, splenic heat, ratio of pancreatic fistula and blood drainage of splenic fossa were found in different treatment groups 7 days, 1 month and 3 months after operation. There was no significant difference in albumin (P0.05), but there were differences in alanine aminotransferase and alanine aminotransferase (P0.05). There was no significant difference in all the observed indexes 6 months after operation (P0.05). Smoking, drinking, hypertension, diabetes and heart disease had no significant effect on the increase of intraoperative risk and postoperative complications (P0.05). The probability of hepatitis C in increasing intraoperative risk and postoperative complications was 4.21 and 4.33 times higher than that in normal subjects. Conclusion splenectomy for portal hypertension with hypersplenism is safe and feasible, and with the development of medical technology, the safety is improved. The upper gastrointestinal bleeding caused by portal hypertension should be operated on according to different indications. Hepatitis B and C were the influential factors to increase the intraoperative risk and postoperative complications.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.6

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