脾切断流术与部分脾动脉栓塞术治疗肝硬化门静脉高压临床疗效分析
发布时间：2018-12-27 18:13
【摘要】：目的：评价脾切断流术与部分脾动脉栓塞术治疗肝硬化门静脉高压症的近期临床疗效。方法：2012年1月至2014年12月期间,新疆医科大学第一附属医院因肝硬化门静脉高压症就诊的84例患者,肝功能Child-Pugh分级：A级16人(19.04%)；B级45人(53.57%),C级23人(27.39%)。行脾切除术+本周血管离断术。同期因肝硬化门静脉高压症就诊的37例患者,肝功能Child-Pugh分级：A级7人(18.91%)；B级18人(48.66%),C级12人(32.43%)。行部分脾动脉栓塞术。观察患者术后3天,7天的WBC、RBC、PLT、ALT、AST及TBIL计数；术后一周门静脉压力；术后并发症；术后住院天数及住院费用。结果：脾切断流组术后3天外周血细胞计数：WBC: (14.56±6.60)×109/L, RBC:(3.64±0.81)×1012/L, PLT:(148.90±67.74)×109/L;部分脾动脉栓塞组术后3天外周血细胞计数：WBC:(7.55±4.29)×09/L, RBC: (3.28±0.88)×1012/L, PLT:(95.33±47.71)×109/L。脾切断流组术后7天外周血细胞计数：WBC:(8.85±3.29)×109/L, RBC:(3.94±1.13)×1012/L, PLT:(329.68±157.63)×109/L;部分脾动脉栓塞组术后7天外周血细胞计数：WBC:(6.25±2.49)×109/L, RBC:(3.49 ±1.01)×1012/L,PLT:(161.19±58.13)×109/L。脾切断流组术后3天ALT53.59±40.32, AST71.21±32.93.17; TBIL35.03±19.25;术后7天ALT40.22±18.17, AST42.18± 17.20; TBIL27.14±12.44;部分脾动脉栓塞组：术后3天ALT47.57±22.05, AST63.81±27.97; TBIL30.12±11.43;术后7天ALT37.20±8.85, AST44.29±12.01; TBIL16.36±4.07;脾切断流组术前及术后一周的平均门静脉压力为：3.78±2.02kPa和2.64±1.10 kPa；部分脾动脉栓塞组病人术前及术后一周的平均门静脉压力为：3.67±1.68kPa和2.91±1.36kPa。平均脾脏栓塞面积58.10±6.04。脾切除术组：出现恶心、呕吐、发热、腹痛、腹胀等症状患者(52例)；术后胸腔积液患者(15例)；左下肺炎(7例)；腹水患者(14例)；门静脉血栓形成(2例)；术后腹腔内出血(1例)；术后死亡(1例)。部分脾动脉栓塞组：几乎所有病人术后出现了不同程度的恶心、呕吐、发热、术后并发胸腔积液患者(9例)；左下肺炎(3例)；腹水患者(11例)；门静脉血栓形成(1例)；脾脏液化坏死(1例)。脾切断流组平均住院天数为：14.5±4.51天,平均住院费用为：46955.40±15122.50元；部分脾动脉栓塞平均住院天数为：13±4.22天,平均住院费用为：38429±10122.02元。结论：脾切断流组近期效果优于部分脾动脉栓塞组。
[Abstract]:Objective: to evaluate the clinical effect of splenectomy and partial splenic artery embolization in the treatment of cirrhotic portal hypertension. Methods: from January 2012 to December 2014, 84 patients with portal hypertension due to cirrhosis in the first affiliated Hospital of Xinjiang Medical University were enrolled in the study. The Child-Pugh classification of liver function was as follows: grade A 16 patients (19.04%); B class 45 (53.57%), C 23 (27.39%). Splenectomy was performed this week. In 37 patients with portal hypertension due to cirrhosis, the Child-Pugh grade of liver function was as follows: grade A 7 (18.91%),); B 18 (48.66%), C 12 (32.43%). Partial splenic artery embolization was performed. The counts of WBC,RBC,PLT,ALT,AST and TBIL were observed on the 3rd and 7th day after operation, portal vein pressure at one week after operation, postoperative complications, postoperative hospitalization days and hospitalization expenses. Results: the peripheral blood cell count (: WBC: () was 14.56 卤6.60 脳 10 9 / L, RBC: was (3.64 卤0.81) 脳 10 12 / L, PLT: was (148.90 卤67.74) 脳 10 9 / L 3 days after splenectomy. In partial splenic artery embolization group, the peripheral blood cell count was 7.55 卤4.29 脳 09 / L, RBC: was (3.28 卤0.88) 脳 10 ~ (12) / L, PLT: was (95.33 卤47.71) 脳 10 ~ (9) 路L ~ (-1) 路L ~ (-1). In the splenectomy group, the peripheral blood cell count was 8.85 卤3.29 脳 10 9 / L, RBC: was (3.94 卤1.13) 脳 10 12 / L, PLT: was (329.68 卤157.63) 脳 10 9 / L; In partial splenic artery embolization group, peripheral blood cell count was 6.25 卤2.49 脳 10 9 / L, RBC: was (3.49 卤1.01) 脳 10 12 / L, RBC: was (161.19 卤58.13) 脳 10 9 / L 路L ~ (-1). ALT53.59 卤40.32, AST71.21 卤32.93.17; TBIL35.03 卤19.25; ALT40.22 卤18.17, AST42.18 卤17.20; TBIL27.14 卤12.44; partial splenic artery embolization group: 3 days after operation: ALT47.57 卤22.05, AST63.81 卤27.97; TBIL30.12 卤11.43; ALT37.20 卤8.85, AST44.29 卤12.01; TBIL16.36 卤4.07. the mean portal vein pressure before and one week after splenectomy was 3.78 卤2.02kPa and 2.64 卤1.10 kPa;. In partial splenic artery embolization group, the mean portal vein pressure was 3.67 卤1.68kPa and 2.91 卤1.36 KPA before and one week after operation. The mean splenic embolization area was 58.10 卤6.04. Splenectomy group: nausea, vomiting, fever, abdominal pain, abdominal distension and other symptoms (52 cases), postoperative pleural effusion (15 cases), left inferior pneumonia (7 cases), ascites (14 cases), portal vein thrombosis (2 cases); Postoperative intraperitoneal hemorrhage (1 case) and postoperative death (1 case). In the partial splenic artery embolization group, almost all the patients had various degrees of nausea, vomiting, fever, pleural effusion (9 cases), left inferior pneumonia (3 cases), ascites (11 cases). Portal vein thrombosis (1 case), splenic liquefaction necrosis (1 case). The average hospitalization days of splenectomy group were 14.5 卤4.51 days, the average hospitalization cost was 46955.40 卤15122.50 yuan, and that of partial splenic artery embolism was 13 卤4.22 days, with an average hospitalization cost of 38429 卤10122.02 yuan. Conclusion: the short-term effect of splenectomy group is better than that of partial splenic artery embolization group.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.34
本文编号：2393422
[Abstract]:Objective: to evaluate the clinical effect of splenectomy and partial splenic artery embolization in the treatment of cirrhotic portal hypertension. Methods: from January 2012 to December 2014, 84 patients with portal hypertension due to cirrhosis in the first affiliated Hospital of Xinjiang Medical University were enrolled in the study. The Child-Pugh classification of liver function was as follows: grade A 16 patients (19.04%); B class 45 (53.57%), C 23 (27.39%). Splenectomy was performed this week. In 37 patients with portal hypertension due to cirrhosis, the Child-Pugh grade of liver function was as follows: grade A 7 (18.91%),); B 18 (48.66%), C 12 (32.43%). Partial splenic artery embolization was performed. The counts of WBC,RBC,PLT,ALT,AST and TBIL were observed on the 3rd and 7th day after operation, portal vein pressure at one week after operation, postoperative complications, postoperative hospitalization days and hospitalization expenses. Results: the peripheral blood cell count (: WBC: () was 14.56 卤6.60 脳 10 9 / L, RBC: was (3.64 卤0.81) 脳 10 12 / L, PLT: was (148.90 卤67.74) 脳 10 9 / L 3 days after splenectomy. In partial splenic artery embolization group, the peripheral blood cell count was 7.55 卤4.29 脳 09 / L, RBC: was (3.28 卤0.88) 脳 10 ~ (12) / L, PLT: was (95.33 卤47.71) 脳 10 ~ (9) 路L ~ (-1) 路L ~ (-1). In the splenectomy group, the peripheral blood cell count was 8.85 卤3.29 脳 10 9 / L, RBC: was (3.94 卤1.13) 脳 10 12 / L, PLT: was (329.68 卤157.63) 脳 10 9 / L; In partial splenic artery embolization group, peripheral blood cell count was 6.25 卤2.49 脳 10 9 / L, RBC: was (3.49 卤1.01) 脳 10 12 / L, RBC: was (161.19 卤58.13) 脳 10 9 / L 路L ~ (-1). ALT53.59 卤40.32, AST71.21 卤32.93.17; TBIL35.03 卤19.25; ALT40.22 卤18.17, AST42.18 卤17.20; TBIL27.14 卤12.44; partial splenic artery embolization group: 3 days after operation: ALT47.57 卤22.05, AST63.81 卤27.97; TBIL30.12 卤11.43; ALT37.20 卤8.85, AST44.29 卤12.01; TBIL16.36 卤4.07. the mean portal vein pressure before and one week after splenectomy was 3.78 卤2.02kPa and 2.64 卤1.10 kPa;. In partial splenic artery embolization group, the mean portal vein pressure was 3.67 卤1.68kPa and 2.91 卤1.36 KPA before and one week after operation. The mean splenic embolization area was 58.10 卤6.04. Splenectomy group: nausea, vomiting, fever, abdominal pain, abdominal distension and other symptoms (52 cases), postoperative pleural effusion (15 cases), left inferior pneumonia (7 cases), ascites (14 cases), portal vein thrombosis (2 cases); Postoperative intraperitoneal hemorrhage (1 case) and postoperative death (1 case). In the partial splenic artery embolization group, almost all the patients had various degrees of nausea, vomiting, fever, pleural effusion (9 cases), left inferior pneumonia (3 cases), ascites (11 cases). Portal vein thrombosis (1 case), splenic liquefaction necrosis (1 case). The average hospitalization days of splenectomy group were 14.5 卤4.51 days, the average hospitalization cost was 46955.40 卤15122.50 yuan, and that of partial splenic artery embolism was 13 卤4.22 days, with an average hospitalization cost of 38429 卤10122.02 yuan. Conclusion: the short-term effect of splenectomy group is better than that of partial splenic artery embolization group.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.34
【参考文献】
相关期刊论文 前1条
1 方迎兵;江艺;吕立志;蔡秋程;张小进;;肝移植治疗脾功能亢进相关终末期肝病[J];中国组织工程研究;2012年05期
，本文编号：2393422
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