CAJ | 학술논문

目的探讨脾切除加贲门周围血管离断术对肝硬化合并脾功能亢进患者肝功能的影响。方法回顾性分析2010年1月至2012年12月在中山大学附属第三医院行脾切除加贲门周围血管离断术的177例肝硬化合并脾功能亢进患者临床资料。其中男120例，女57例；平均年龄（54±13）岁。所有患者均签署知情同意书，符合医学伦理学规定。术中首先行脾切除术，然后离断食管胃底扩张的静脉。观察患者术前及术后5 d、10 d、3个月血常规、肝功能的变化情况。多组计量资料比较采用单因素方差分析和LSD-t检验。结果患者脾功能亢进明显改善，术后5 d、10 d、3个月WBC和Plt均较术前明显升高（LSD-t=14.37，10.67，6.60和5.06，11.43，12.10；P<0.05）。患者肝功能亦明显改善，术后10 d和3个月的AST、ALT、TB较术前明显降低（LSD-t=7.80，10.09，8.21和10.76，12.51，11.13；P<0.05）。结论脾切除加贲门周围血管离断术不仅能治疗肝硬化合并脾功能亢进患者的脾功能亢进，而且能明显改善患者的肝功能。
목적탐토비절제가분문주위혈관리단술대간경화합병비공능항진환자간공능적영향。방법회고성분석2010년1월지2012년12월재중산대학부속제삼의원행비절제가분문주위혈관리단술적177례간경화합병비공능항진환자림상자료。기중남120례，녀57례；평균년령（54±13）세。소유환자균첨서지정동의서，부합의학윤리학규정。술중수선행비절제술，연후리단식관위저확장적정맥。관찰환자술전급술후5 d、10 d、3개월혈상규、간공능적변화정황。다조계량자료비교채용단인소방차분석화LSD-t검험。결과환자비공능항진명현개선，술후5 d、10 d、3개월WBC화Plt균교술전명현승고（LSD-t=14.37，10.67，6.60화5.06，11.43，12.10；P<0.05）。환자간공능역명현개선，술후10 d화3개월적AST、ALT、TB교술전명현강저（LSD-t=7.80，10.09，8.21화10.76，12.51，11.13；P<0.05）。결론비절제가분문주위혈관리단술불부능치료간경화합병비공능항진환자적비공능항진，이차능명현개선환자적간공능。
Objective To investigate the impact of splenectomy with periesophagogastric devascularization on liver function of patients with liver cirrhosis and hypersplenism. Methods Clinical data of 177 patients with liver cirrhosis and hypersplenism who underwent splenectomy with periesophagogastric devascularization in the Third Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2012 were retrospectively analyzed. There were 120 males and 57 females with the mean age of (54±13) years old. The informed consents of all patients were obtained and the ethical committee approval was received. Firstly splenectomy was performed during the operation, and then the dilated esophageal and gastric fundus veins were dissected and cut off. The changes of blood routine and liver function of the patients before and 5 d, 10 d, 3 months after operations were observed. The measurement data between multiple groups were compared by one-way analysis of variance and LSD-t test. Results The hypersplenism of patients improved markedly. The white blood cell (WBC) and platelets (Plt) levels 5 d, 10 d, 3 months after operations signiifcantly increased when compared with those before operations (LSD-t=14.37, 10.67, 6.60 and 5.06, 11.43, 12.10;P<0.05). And the liver function of patients also improved markedly. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB) levels 10 d, 3 months after operations signiifcantly decreased when compared with those before operations (LSD-t=7.80, 10.09, 8.21 and 10.76, 12.51, 11.13;P<0.05). Conclusion Splenectomy with periesophagogastric devascularization can not only cure the hypersplenism of patients with liver cirrhosis and hypersplenism, but also markedly improve the liver function of them.