發(fā)布時間：2018-12-27 18:13

【摘要】：目的：評價脾切斷流術(shù)與部分脾動脈栓塞術(shù)治療肝硬化門靜脈高壓癥的近期臨床療效。方法：2012年1月至2014年12月期間,新疆醫(yī)科大學(xué)第一附屬醫(yī)院因肝硬化門靜脈高壓癥就診的84例患者,肝功能Child-Pugh分級：A級16人(19.04%)；B級45人(53.57%),C級23人(27.39%)。行脾切除術(shù)+本周血管離斷術(shù)。同期因肝硬化門靜脈高壓癥就診的37例患者,肝功能Child-Pugh分級：A級7人(18.91%)；B級18人(48.66%),C級12人(32.43%)。行部分脾動脈栓塞術(shù)。觀察患者術(shù)后3天,7天的WBC、RBC、PLT、ALT、AST及TBIL計數(shù)；術(shù)后一周門靜脈壓力；術(shù)后并發(fā)癥；術(shù)后住院天數(shù)及住院費用。結(jié)果：脾切斷流組術(shù)后3天外周血細(xì)胞計數(shù)：WBC: (14.56±6.60)×109/L, RBC:(3.64±0.81)×1012/L, PLT:(148.90±67.74)×109/L;部分脾動脈栓塞組術(shù)后3天外周血細(xì)胞計數(shù)：WBC:(7.55±4.29)×09/L, RBC: (3.28±0.88)×1012/L, PLT:(95.33±47.71)×109/L。脾切斷流組術(shù)后7天外周血細(xì)胞計數(shù)：WBC:(8.85±3.29)×109/L, RBC:(3.94±1.13)×1012/L, PLT:(329.68±157.63)×109/L;部分脾動脈栓塞組術(shù)后7天外周血細(xì)胞計數(shù)：WBC:(6.25±2.49)×109/L, RBC:(3.49 ±1.01)×1012/L,PLT:(161.19±58.13)×109/L。脾切斷流組術(shù)后3天ALT53.59±40.32, AST71.21±32.93.17; TBIL35.03±19.25;術(shù)后7天ALT40.22±18.17, AST42.18± 17.20; TBIL27.14±12.44;部分脾動脈栓塞組：術(shù)后3天ALT47.57±22.05, AST63.81±27.97; TBIL30.12±11.43;術(shù)后7天ALT37.20±8.85, AST44.29±12.01; TBIL16.36±4.07;脾切斷流組術(shù)前及術(shù)后一周的平均門靜脈壓力為：3.78±2.02kPa和2.64±1.10 kPa；部分脾動脈栓塞組病人術(shù)前及術(shù)后一周的平均門靜脈壓力為：3.67±1.68kPa和2.91±1.36kPa。平均脾臟栓塞面積58.10±6.04。脾切除術(shù)組：出現(xiàn)惡心、嘔吐、發(fā)熱、腹痛、腹脹等癥狀患者(52例)；術(shù)后胸腔積液患者(15例)；左下肺炎(7例)；腹水患者(14例)；門靜脈血栓形成(2例)；術(shù)后腹腔內(nèi)出血(1例)；術(shù)后死亡(1例)。部分脾動脈栓塞組：幾乎所有病人術(shù)后出現(xiàn)了不同程度的惡心、嘔吐、發(fā)熱、術(shù)后并發(fā)胸腔積液患者(9例)；左下肺炎(3例)；腹水患者(11例)；門靜脈血栓形成(1例)；脾臟液化壞死(1例)。脾切斷流組平均住院天數(shù)為：14.5±4.51天,平均住院費用為：46955.40±15122.50元；部分脾動脈栓塞平均住院天數(shù)為：13±4.22天,平均住院費用為：38429±10122.02元。結(jié)論：脾切斷流組近期效果優(yōu)于部分脾動脈栓塞組。
[Abstract]:Objective: to evaluate the clinical effect of splenectomy and partial splenic artery embolization in the treatment of cirrhotic portal hypertension. Methods: from January 2012 to December 2014, 84 patients with portal hypertension due to cirrhosis in the first affiliated Hospital of Xinjiang Medical University were enrolled in the study. The Child-Pugh classification of liver function was as follows: grade A 16 patients (19.04%); B class 45 (53.57%), C 23 (27.39%). Splenectomy was performed this week. In 37 patients with portal hypertension due to cirrhosis, the Child-Pugh grade of liver function was as follows: grade A 7 (18.91%),); B 18 (48.66%), C 12 (32.43%). Partial splenic artery embolization was performed. The counts of WBC,RBC,PLT,ALT,AST and TBIL were observed on the 3rd and 7th day after operation, portal vein pressure at one week after operation, postoperative complications, postoperative hospitalization days and hospitalization expenses. Results: the peripheral blood cell count (: WBC: () was 14.56 鹵6.60 脳 10 9 / L, RBC: was (3.64 鹵0.81) 脳 10 12 / L, PLT: was (148.90 鹵67.74) 脳 10 9 / L 3 days after splenectomy. In partial splenic artery embolization group, the peripheral blood cell count was 7.55 鹵4.29 脳 09 / L, RBC: was (3.28 鹵0.88) 脳 10 ~ (12) / L, PLT: was (95.33 鹵47.71) 脳 10 ~ (9) 路L ~ (-1) 路L ~ (-1). In the splenectomy group, the peripheral blood cell count was 8.85 鹵3.29 脳 10 9 / L, RBC: was (3.94 鹵1.13) 脳 10 12 / L, PLT: was (329.68 鹵157.63) 脳 10 9 / L; In partial splenic artery embolization group, peripheral blood cell count was 6.25 鹵2.49 脳 10 9 / L, RBC: was (3.49 鹵1.01) 脳 10 12 / L, RBC: was (161.19 鹵58.13) 脳 10 9 / L 路L ~ (-1). ALT53.59 鹵40.32, AST71.21 鹵32.93.17; TBIL35.03 鹵19.25; ALT40.22 鹵18.17, AST42.18 鹵17.20; TBIL27.14 鹵12.44; partial splenic artery embolization group: 3 days after operation: ALT47.57 鹵22.05, AST63.81 鹵27.97; TBIL30.12 鹵11.43; ALT37.20 鹵8.85, AST44.29 鹵12.01; TBIL16.36 鹵4.07. the mean portal vein pressure before and one week after splenectomy was 3.78 鹵2.02kPa and 2.64 鹵1.10 kPa;. In partial splenic artery embolization group, the mean portal vein pressure was 3.67 鹵1.68kPa and 2.91 鹵1.36 KPA before and one week after operation. The mean splenic embolization area was 58.10 鹵6.04. Splenectomy group: nausea, vomiting, fever, abdominal pain, abdominal distension and other symptoms (52 cases), postoperative pleural effusion (15 cases), left inferior pneumonia (7 cases), ascites (14 cases), portal vein thrombosis (2 cases); Postoperative intraperitoneal hemorrhage (1 case) and postoperative death (1 case). In the partial splenic artery embolization group, almost all the patients had various degrees of nausea, vomiting, fever, pleural effusion (9 cases), left inferior pneumonia (3 cases), ascites (11 cases). Portal vein thrombosis (1 case), splenic liquefaction necrosis (1 case). The average hospitalization days of splenectomy group were 14.5 鹵4.51 days, the average hospitalization cost was 46955.40 鹵15122.50 yuan, and that of partial splenic artery embolism was 13 鹵4.22 days, with an average hospitalization cost of 38429 鹵10122.02 yuan. Conclusion: the short-term effect of splenectomy group is better than that of partial splenic artery embolization group.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.34

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