全科医学临床与教育
全科醫學臨床與教育
전과의학림상여교육
CLINICAL EDUCATION OF GENERAL PRACTICE
2013年
4期
402-404
,共3页
门静脉高压%消化道出血%脾切除术%贲门周围血管离断术
門靜脈高壓%消化道齣血%脾切除術%賁門週圍血管離斷術
문정맥고압%소화도출혈%비절제술%분문주위혈관리단술
portal hypertension%gastrointestinal hemorrhage%splenectomy%pericardial devascularization
目的比较脾部分切除术与脾完全切除术联合贲门周围血管离断术对门静脉高压上消化道出血患者的疗效。方法37例门静脉高压上消化道出血患者随机分为两组，A组20例，行脾大部切除术，B组17例，行脾完全切除术。比较两组术后近期并发症、手术前后门静脉压力、血小板计数、免疫球蛋白水平差异。结果 A组术后14例（70.00%）发热，低于B组的17例（100%），差异有统计学意义（χ2=6.09，P＜0.05）；术后A、B两组门静脉压力分别为（2.92±0.40）kPa、（2.85±0.33）kPa，均较术前的（3.83±0.45）kPa、（3.76±0.47）kPa明显降低，差异均有统计学意义（t分别=7.12、7.42，P均＜0.05）；术后2周A、B组血小板计数为（184.65±35.91）×109/L、（255.18±67.04）×109/L，均较术前的（78.92±13.42）×109/L、（77.47±18.13）×109/L明显升高，且B组明显高于A组，差异均有统计学意义（t分别=12.33、10.55、3.89，P均＜0.05）；A组术后IgM水平为（1.45±0.43）g/L，高于术前（1.14±0.24）g/L，且明显高于B组术后（0.88±0.12） g/L，差异均有统计学意义（t分别=2.82、5.67，P均＜0.05）。结论脾大部切除术联合贲门周围血管离断术既能达到降低门静脉压力、解除脾功能亢进、控制上消化道出血的疗效，还保留了脾脏部分免疫功能。
目的比較脾部分切除術與脾完全切除術聯閤賁門週圍血管離斷術對門靜脈高壓上消化道齣血患者的療效。方法37例門靜脈高壓上消化道齣血患者隨機分為兩組，A組20例，行脾大部切除術，B組17例，行脾完全切除術。比較兩組術後近期併髮癥、手術前後門靜脈壓力、血小闆計數、免疫毬蛋白水平差異。結果 A組術後14例（70.00%）髮熱，低于B組的17例（100%），差異有統計學意義（χ2=6.09，P＜0.05）；術後A、B兩組門靜脈壓力分彆為（2.92±0.40）kPa、（2.85±0.33）kPa，均較術前的（3.83±0.45）kPa、（3.76±0.47）kPa明顯降低，差異均有統計學意義（t分彆=7.12、7.42，P均＜0.05）；術後2週A、B組血小闆計數為（184.65±35.91）×109/L、（255.18±67.04）×109/L，均較術前的（78.92±13.42）×109/L、（77.47±18.13）×109/L明顯升高，且B組明顯高于A組，差異均有統計學意義（t分彆=12.33、10.55、3.89，P均＜0.05）；A組術後IgM水平為（1.45±0.43）g/L，高于術前（1.14±0.24）g/L，且明顯高于B組術後（0.88±0.12） g/L，差異均有統計學意義（t分彆=2.82、5.67，P均＜0.05）。結論脾大部切除術聯閤賁門週圍血管離斷術既能達到降低門靜脈壓力、解除脾功能亢進、控製上消化道齣血的療效，還保留瞭脾髒部分免疫功能。
목적비교비부분절제술여비완전절제술연합분문주위혈관리단술대문정맥고압상소화도출혈환자적료효。방법37례문정맥고압상소화도출혈환자수궤분위량조，A조20례，행비대부절제술，B조17례，행비완전절제술。비교량조술후근기병발증、수술전후문정맥압력、혈소판계수、면역구단백수평차이。결과 A조술후14례（70.00%）발열，저우B조적17례（100%），차이유통계학의의（χ2=6.09，P＜0.05）；술후A、B량조문정맥압력분별위（2.92±0.40）kPa、（2.85±0.33）kPa，균교술전적（3.83±0.45）kPa、（3.76±0.47）kPa명현강저，차이균유통계학의의（t분별=7.12、7.42，P균＜0.05）；술후2주A、B조혈소판계수위（184.65±35.91）×109/L、（255.18±67.04）×109/L，균교술전적（78.92±13.42）×109/L、（77.47±18.13）×109/L명현승고，차B조명현고우A조，차이균유통계학의의（t분별=12.33、10.55、3.89，P균＜0.05）；A조술후IgM수평위（1.45±0.43）g/L，고우술전（1.14±0.24）g/L，차명현고우B조술후（0.88±0.12） g/L，차이균유통계학의의（t분별=2.82、5.67，P균＜0.05）。결론비대부절제술연합분문주위혈관리단술기능체도강저문정맥압력、해제비공능항진、공제상소화도출혈적료효，환보류료비장부분면역공능。
Objective To explore the effects of subtotal and total splenectomy combined with pericardial devasculariza-tion in the treatment of upper gastrointestinal bleeding due to portal hypertension and provide the reference for selecting operation. Methods A total of 37 Patients were randomly divided into two groups. 20 cases in group A underwent subtotal splenectomy and 17 cases in group B underwent total splenectomy. The postoperative complications, portal venous pres-sure, platelet count and immuno- globulin levels between two groups were compared. Results There were 14 cases (70.00%) in group A had fever after operation which was significantly less than that of 17 cases (100%) in group B (χ2=6.09,P<0.05). The portal venous pressure of group A and B after operation were(2.92 ± 0.40) kPa and(2.85± 0.33) kPa which were significantly lower than those preoperative (t=7.12,7.42,P<0.05). After 2 weeks , platelet count of group A and B were(184.65±35.91)×109/L and (255.18±67.04)×109/L which were significantly higher than those preoperative(t=12.33,10.55,P<0.05). The platelet count of group B was significantly higher than that of group A (t=3.89,P<0.05). The IgM of group A at postoperative was(1.45±0.43) g/L which was significantly higher than that preoperative(1.14±0.26) g/L and that of group B postoperative (0.88±0.12) g/L (t=2.82,5.67,P<0.05). Conclusions Subtotal splenectomy combined with pericardial devascularization can not only reduce portal venous pressure, relieve hypersplenism and control upper gas-trointestinal hemorrhage, but also retain part of the immune function of spleen.
