【摘要】：目的肝硬化作為門靜脈高壓常見的發(fā)病原因之一,其所導致的肝功能代償引起門靜脈高壓是脾功能亢進的最常見原因。目前關于門靜脈高壓合并脾功能亢進的治療途徑主要是外科手術。本研究通過收集2013年1月-2014年12月在蘭州大學第一醫(yī)院住院的門靜脈高壓合并脾功能亢進施行脾切除術的患者為研究對象,探討門靜脈高壓合并脾功能亢進施行脾切除同圍術期安全性的關聯(lián)以及脾切除對機體的影響。方法收集2013年1月-2014年12月在蘭州大學第一醫(yī)院住院的門靜脈高壓合并脾功能亢進施行脾切除術116例患者,依據(jù)患者手術指征分別行單純脾切除術、脾切除+斷流術、脾切除+分流術以及脾切除+聯(lián)合斷流分流術,觀察患者術前以及術后7天、1個月、3個月、6個月的恢復指標、并發(fā)癥指標等。結果不同處理組之間性別、吸煙、飲酒、高血壓、糖尿病、心臟病、乙肝、丙肝、肝功能A級、B級的比率、年齡、體重、身高、脾臟長徑及厚度、血小板、血紅蛋白、白細胞、尿素氮、肌酐、總膽紅素、谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、術中膠體液用量均無明顯差異(P0.05),在手術出血量、晶體液、輸血人數(shù)、未輸血人數(shù)方面、橫結腸脾曲和胰尾損傷、手術總時間方面存在差異(P0.05)。術后7天、1個月、3個月不同處理組之間出現(xiàn)左側(cè)胸腔積液、脾窩局限性積液、左膈下積液、切口感染、脾熱、胰瘺的比率以及脾窩血性引流量、白蛋白指標均無明顯差異(P0.05),而在谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶指標方面存在差異(P0.05)；術后6個月所有觀察指標間均無明顯差異(P0.05)。吸煙、飲酒、高血壓、糖尿病、心臟病對于增加術中風險及術后并發(fā)癥發(fā)生率未有顯著影響(P0.05),乙肝、丙肝對于增加術中風險及術后并發(fā)癥發(fā)生率的概率是正常人群的4.21倍和4.33倍。結論門靜脈高壓癥合并脾功能亢進施行脾切除術是安全可行的,且隨著醫(yī)療技術發(fā)展,較以往安全性有所提高,門靜脈高壓癥所引起的上消化道出血應依據(jù)不同指征采取不同手術方式；既往乙肝、丙肝是增加術中風險及術后并發(fā)癥發(fā)生率的影響因素。
[Abstract]:Objective as one of the common causes of portal hypertension, liver cirrhosis is the most common cause of hypersplenism. Surgical treatment is the main treatment of portal hypertension with hypersplenism. Patients with portal hypertension combined with hypersplenectomy were collected from January 2013 to December 2014 in the first Hospital of Lanzhou University. To investigate the relationship between splenectomy and perioperative safety of portal hypertension combined with hypersplenism and the effect of splenectomy on body. Methods from January 2013 to December 2014, 116 patients with portal hypertension combined with hypersplenism who were hospitalized in the first Hospital of Lanzhou University were divided into two groups: simple splenectomy and splenectomy. Splenectomy shunt and splenectomy combined with devascularization were observed before and 7 days, 1 month, 3 months and 6 months after operation. Results the sex, smoking, drinking, hypertension, diabetes, heart disease, hepatitis B, hepatitis C, liver function A, B grade, age, weight, height, spleen length and thickness, platelet, hemoglobin, blood platelet, hemoglobin, There was no significant difference in white blood cell, urea nitrogen, creatinine, total bilirubin, glutamic oxaloacetic transaminase, alanine aminotransferase and intraoperative colloidal fluid (P0.05). There was significant difference in the total operation time between splenic curvature of transverse colon and pancreatic tail injury (P0.05). Left pleural effusion, localized effusion in splenic fossa, subphrenic effusion, incision infection, splenic heat, ratio of pancreatic fistula and blood drainage of splenic fossa were found in different treatment groups 7 days, 1 month and 3 months after operation. There was no significant difference in albumin (P0.05), but there were differences in alanine aminotransferase and alanine aminotransferase (P0.05). There was no significant difference in all the observed indexes 6 months after operation (P0.05). Smoking, drinking, hypertension, diabetes and heart disease had no significant effect on the increase of intraoperative risk and postoperative complications (P0.05). The probability of hepatitis C in increasing intraoperative risk and postoperative complications was 4.21 and 4.33 times higher than that in normal subjects. Conclusion splenectomy for portal hypertension with hypersplenism is safe and feasible, and with the development of medical technology, the safety is improved. The upper gastrointestinal bleeding caused by portal hypertension should be operated on according to different indications. Hepatitis B and C were the influential factors to increase the intraoperative risk and postoperative complications.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.6

【共引文獻】

相關期刊論文 前3條

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本文編號：2376428