摘要
目的探讨肝硬化门静脉高压合并脾动脉盗血综合征患者贲门周围血管断流手术前后血流动力学变化，为肝硬化门静脉高压合并脾功能亢进患者的外科治疗提供理论依据。方法收集2015年1月至2017年1月安徽中医药大学第一附属医院收治的30例肝硬化门静脉高压合并食管胃底静脉曲张出血患者临床资料，所有患者均行脾切除加贲门周围血管离断手术。选取同期30例健康体检者作为对照组。超声观测两组肝固有动脉、脾门处脾动静脉以及门静脉主干血流动力学变化，分析研究组手术前后肝固有动脉和门静脉血流动力学变化。比较两组患者手术前后生化指标。结果分析显示研究组术前脾动静脉及门静脉血流动力学指标均较对照组升高，肝固有动脉血流速度[（35．3±5．1）cm／s比（53．1±7．0）cm／s]及血流量[（175．9±30．5）ml／min比（297．0±48．3）ml／min]较对照组减少，差异具有统计学意义（P〈0．05）。研究组术后肝固有动脉血流速度[（60．7±11．9）cm／s比（35．3±5．1）cm／s]及血流量[（388．8±79．6）ml／min比（175．9±30．5）ml／min]较术前明显增加；术后白细胞[（7．9±3．8）×10^9／L比（2．8±1．4）×10^9／L）]、血小板[（491．3±194．9）×10^9／L比（47．4±16．0）×10^9／L]、胆红素[（15．0±10．6）μmol／L比（24．4±13．8）μmol／L]、丙氨酸转氨酶[（32．9±8．6）U／L比（43．4±16．6）U／L）]较术前明显改善，差异具有统计学意义（P〈0．05）。结论肝硬化门静脉高压继发脾功能亢进患者存在脾动脉盗血。脾切除加贲门周围血管离断术是肝硬化门静脉高压合并食管胃底静脉曲张出血患者的安全有效的治疗措施，能够恢复肝脏血流灌注，改善肝脏功能。
Objective To study the hemodynamic changes before and after splenectomy plus per- iesophagogastric devascularization in patients with splenic artery steal syndrome （SASS） so as to provide a theoretical basis for the treatment of portal hypertension concomitant with hypersplenism. Methods The da- tabase of 30 patients who underwent splenectomy plus devascularization from January 2015 to January 2017 was studied retrospectively. Color Doppler ultrasound was performed to detect hemodynamic changes in the hepatic artery, splenic artery, splenic vein and portal vein in patients with portal hypertension and in healthy controls. The outcomes between preoperative and postoperative biochemical indicators were compared. Re- suits The hemodynamic indexes of splenic artery, splenic vein and portal vein in the study group were sig- nificantly higher than those in the control group （P 〈 0. 05）. The peak systolic velocity [ （35.3 ± 5.1 ） cm/s vs. （53.1 ± 7.0） cm/s ] and blood flow [ （ 175.9 ± 30. 5 ） ml/min vs. （297.0 ± 48. 3 ） ml/min） ] of the hepatic artery were significantly lower than those of the control group （ P 〈 0. 05 ）. The peak systolic velocity [ （60. 7 ± 11.9） cm/s vs. （35.3 ±5.1） cm/s] and blood flow [ （388.8 ±79.6） ml/min vs. （ 175.86 ± 30. 46 ） ml/min] of the hepatic artery increased significantly after operation （ P 〈 0. 05 ）. After splenectomy, the levels of the leucocyte [（7.9 ± 3.8） ×10^9/L vs. （2.8 ± 1.4） ×10^9/L）I, thrombocyte [（491.3±194.9） ×10^9/L vs. （47.4 ± 16.0） ×10^9/L）], bilirubin [（15.0 ± 10.6） μmol/L vs. （24.4 ± 13.8） μmol/L） 1 and transaminase [ （32. 94 ± 8. 57 ） U/L vs. （43.37 ± 16. 59） U/L） ] recovered when compared with the preoperative data （P 〈 0.05 ）. Conclusions SASS was detected in cirrhotic patients who had portal hypertension concomitant with hypersplenism. Spleneetomy plus periesophagogastric devaseularization were effective and safe for cirrhotic patients with hypersplenism and concomitant esophageal and gastric varieeal bleeding.
作者
黄龙
于庆生
王佳佳
Huang Long;Yu Qingsheng;Wang Jiajia.(Department of General Surgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2018年第5期304-308,共5页
Chinese Journal of Hepatobiliary Surgery
基金
2016年度国家重点专科（中医外科）开放性课题（2016zkkf001）
作者简介
通信作者：于庆生，电子信箱：qsy6312@163．com
