CAJ | 학술논문

目的：分析门脉高压症合并脾功能亢进（简称门脉高压性脾亢）患者行脾切除术的近远期疗效和切脾对机体的影响。方法收集2004年1月至2014年1月收治的351例门脉高压性脾亢患者，回顾性分析病例资料以及行脾切除术后近期疗效评价，并进行远期随访调查，重点了解术后感染、肝癌、肝功能、血细胞变化以及系统疾病的控制情况等。结果患者行脾切除术后，近期内受损的肝功能和血细胞得以恢复。近期内出现黄疸者42例，腹水31例，发热34例，上消化道再出血者13例，予以积极对症处理后均康复出院。远期随访87例发现，29例在切脾约2~33（中位11.4）个月后出现肝功能下降，血清白蛋白水平下降和转氨酶水平升高；原伴发的糖尿病、高血压病和消化系统疾病切脾后较切脾前病情容易控制；继发肝癌者6例，4例死亡，未见有脾切除后凶险性感染。结论门脉高压症合并脾功能亢进患者进行脾切除术对机体有利有弊，故对于此类脾大患者不能一律予以切除。
목적：분석문맥고압증합병비공능항진（간칭문맥고압성비항）환자행비절제술적근원기료효화절비대궤체적영향。방법수집2004년1월지2014년1월수치적351례문맥고압성비항환자，회고성분석병례자료이급행비절제술후근기료효평개，병진행원기수방조사，중점료해술후감염、간암、간공능、혈세포변화이급계통질병적공제정황등。결과환자행비절제술후，근기내수손적간공능화혈세포득이회복。근기내출현황달자42례，복수31례，발열34례，상소화도재출혈자13례，여이적겁대증처리후균강복출원。원기수방87례발현，29례재절비약2~33（중위11.4）개월후출현간공능하강，혈청백단백수평하강화전안매수평승고；원반발적당뇨병、고혈압병화소화계통질병절비후교절비전병정용역공제；계발간암자6례，4례사망，미견유비절제후흉험성감염。결론문맥고압증합병비공능항진환자진행비절제술대궤체유리유폐，고대우차류비대환자불능일률여이절제。
Objective To summarize and analyze the efficacy by observing the short-and long-term follow-up of patients undergoing splenectomy for hypersplenism with portal hypertension. Methods Clinical data of 351 cases was collected involved in portal hypertension and hypersplenism. The reviewed parameters included the occurrence of postoperative infection, emergence of secondary hepatic cancer, changes of liver functions and peripheral blood cells, and the condition control of diabetes mellitus, cardiovascular system and alimentary system diseases. Results After resection of the pathologic spleen, the functions of injured liver and blood cells count gradually improved and recovered to normal levels in a short period. The short-term complications, mainly including 42 cases with jaundice, 31 with ascites, 34 with fever, and 13 with rehaemorrhagia of upper gastrointestinal tract, alleviated by prompt symptomatic treatment. In the long-term follow-up of 87 cases, 29 were detected declined liver functions, decreased serum albumin, and increased transaminase about 2~33(medians 11.4) months postoperatively. 6 cases had a secondary liver cancer, 4 patients died and there was no overwhelming postsplenectomy infection (OPSI). Furthermore, the condition control of diabetes mellitus, cardiovascular system and alimentary system disease obviously improved after splenectomy. Conclusion Splenectomy has both advantages and shortcomings for patients of hypersplenism with portal hypertension and needs further exploration.