CAJ | 학술논문

目的：探讨门奇断流术后胸腔积液的危险因素及防治措施。方法回顾性分析2008年3月至2012年9月收治的77例行门奇断流术患者的临床资料。结果7例（7/77，9.1%）术前有行非选择性脾动脉栓塞。70例（70/77，90.9%）采用脾切除+贲门周围血管离断术式，7例（7/77，9.1%）采用改良Sugiura术式。平均住院时间为（16.7±2.2）d，住院期间无一例死亡及行二次手术。门奇断流术后胸腔积液发生12例（15.6%）。单因素分析提示门奇断流术后胸腔积液的发生与术前肝功能、脾脏大小、脾周粘连、手术方式及术前脾动脉栓塞有关，差异有统计学意义（P<0.05）；多因素Logistic回归分析提示手术方式、术前脾动脉栓塞是影响胸腔积液发生的独立因素（P<0.05）。结论通过避免术前脾动脉栓塞、选择适当的手术方式并改进手术操作，可有效减少门奇断流术后胸腔积液的发生。
목적：탐토문기단류술후흉강적액적위험인소급방치조시。방법회고성분석2008년3월지2012년9월수치적77례행문기단류술환자적림상자료。결과7례（7/77，9.1%）술전유행비선택성비동맥전새。70례（70/77，90.9%）채용비절제+분문주위혈관리단술식，7례（7/77，9.1%）채용개량Sugiura술식。평균주원시간위（16.7±2.2）d，주원기간무일례사망급행이차수술。문기단류술후흉강적액발생12례（15.6%）。단인소분석제시문기단류술후흉강적액적발생여술전간공능、비장대소、비주점련、수술방식급술전비동맥전새유관，차이유통계학의의（P<0.05）；다인소Logistic회귀분석제시수술방식、술전비동맥전새시영향흉강적액발생적독립인소（P<0.05）。결론통과피면술전비동맥전새、선택괄당적수술방식병개진수술조작，가유효감소문기단류술후흉강적액적발생。
Objective To investigate the risk factors for pleural effusion and the corresponding prophylactico-therapeutic measures after pericardial devascularization in patients with portal hypertension. Methods Seventy-seven cases with portal hypertension after hepatitis undergoing pericardial devascularization in the Third Department of General Surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from Mar 2008 to Sep 2012 were selected for a retrospective study.Results In these 77 patients, 7 cases(9.1%) accepted nonselective splenic embolism before operation. The types of operation were divided into two groups, 70 cases(90.9%) accepted splenectomy plus pericardial devascularization without esophageal transection, the other 7 cases(9.1%) were given modified Sugiura operation. All patients recovered after operation with an average hospitalization time of (16.7±2.2) days. There was no death or second operation in these 77 cases. Pleural effusion emerged in 12 cases(15.6%) after the operation. By using single factor analysis, the pleural effusion after pericardial devascularization was related to the types of operation, hepatic Child-Pugh classification and nonselective splenic embolism before operation, and to the size of spleen, spleen adhesions around. The difference was statistically significant (P<0.05). By using multiple factors logistic regression analysis, the type of operation and the nonselective splenic embolism before operation were the independent factors of pleural effusion (P<0.05).Conculsion Through avoiding nonselective splenic embolism before operation, selecting appropriate operation type and improving operational skills, we can reduce the occurrence of pleural effusion after pericardial devascularization.