摘要
目的:探讨肝硬化门静脉高压症伴血小板重度降低患者行脾切除并贲门周围血管离断术的可行性.方法:回顾性分析郑州大学第一附属医院肝胆胰外科2009-09/2014-09收治的脾切除并贲门周围血管离断术患者的临床资料.根据术前血小板降低程度分为重度、中度、轻度3组,对比分析3组患者的临床资料.结果:184例患者的临床资料纳入分析,3组患者基线临床资料匹配(P>0.05);血小板重度降低组术后血小板计数恢复至正常范围内所用时间为10 d,较轻度、重度组长;血小板重度降低组患者术后3 d日平均引流量(950 mL±279 mL)、血红蛋白丢失量(46.6 g±7.4 g)、住院天数(16.0 d±3.5 d),均大于中度组与轻度组,且差异均有统计学意义(P<0.01);血小板重度降低组患者再出血率、Ⅰ/Ⅱ级及Ⅲ/Ⅳ级门静脉血栓形成率分别为11.62%、23.26%和4.65%,3组之间差异无统计学意义(P>0.05);血小板重度降低组患者术后1年、3年和5年的生存率分别为95.3%、88.4%和76.7%,3组之间差异无统计学意义(P>0.05).结论:肝硬化门静脉高压症并重度血小板降低的患者,通过积极的围手术期处理,脾切除并贲门周围血管离断术可能是安全可行的.
AIM： To evaluate the feasibility of splenectomy with pericardial de-vascularization in patients with intra-hepatic portal hypertension and severe thrombocytopenia.METHODS： We retrospectively analyzed the clinical data of patients who had undergone splenectomy with pericardial de-vascularization from September 2009 to September 2014 at the Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University. According to the severity of thrombocytopenia, patients were divided into three groups： severe, moderate and mild groups.RESULTS： A total of 184 patients were included in the analysis; the baseline characteristics of the three groups were matched（P〈0.05）. For the severe group, it took 10 days for platelet return to normal range after surgery, and the time was longer than that for the moderate and mild groups. The average drainage volume within 3 days after surgery, intraoperatve blood loss andlength of hospital stay in the severe group were 950 mL ± 279 mL, 46.6 g ± 7.4 g and 16.0 d ± 3.5 d, respectively; these values were significantly higher than those in the other two groups（P〈0.01）. The bleeding rate and the rates of grade Ⅰ/Ⅱ and grade Ⅲ/Ⅳ portal vein thrombosis in the severe group were 11.62%, 23.26% and 4.65%, respectively, and these value were significantly higher than those in the other two groups（P〈0.05）. The cumulative survival rates at 1 year, 3 years, and 5 years were 95.3%, 88.4% and 76.7%, respectively, and there were no significant differences in the three groups（P〈0.05）.CONCLUSION： Through aggressive perioperative management, splenectomy and pericardial de-vascularization may be feasible in patients with portal hypertension and severe thrombocytopenia.
出处
《世界华人消化杂志》
CAS
2016年第3期436-442,共7页
World Chinese Journal of Digestology
