摘要
目的探讨远端脾肾分流术（distal splenorenal shunt，DSRS）治疗门静脉高压症的效果和现实意义。方法回顾性分析2009年1月至2015年12月收治的远端脾肾分流术患者16例．回顾性分析手术前后自由门静脉压力（free portal pressure，FPP）、血常规、肝功能等资料，观察近期并发症情况、远期吻合口情况和再出血率。结果分流术前后FPP分别为（43±9）cmH2O和（31±6）cmH2O，FPP下降达29．1％（t=7．326，P〈0．01）。术后外周血白细胞、血清总胆红素升高（t=-3．462，t=-2．822．P〈0．05），差异有统计学意义；血小板、白蛋白较术前变化差异无统计学意义。术后7例患者发生一项或多项并发症，近期总体并发症发生率43．8％（7／16），包括门静脉血栓形成5例（31．3％）、大量腹水4例（25．0％）、肺部感染1例（6．3％）和伤口感染1例（6．3％）。16例患者均获得随访，增强CT复查分流吻合口情况，均未见狭窄，术后再出血1例（6．3％），因肝功能衰竭死亡1例（6．3％）。结论远端脾肾静脉分流术治疗门静脉高压症的疗效确切。
Objective To evaluate the effect of distal splenorenal shunts （DSRS） in treatment of portal hypertension. Methods A retrospective analysis was made on 1＂6 patients undergoing DSRS between 2009 and 2015 in a single institution. Perioperative free portal pressure （FPP）, blood routine, liver function were collected and analyzed. Postoperative complications, long-term anastomotic status and the rate of re-bleeding were observed. Results Before and after DSRS, FPP were （43 ＋ 9） cmH2O and （ 31 ＋ 6） cmH2O, a decrease of 29. 1% （t = 7. 326, P 〈 0. 01 ）. Postoperative serum total bilirubin and peripheral blood leukocyte increased significantly （t = - 3. 462, t = - 2. 822, P 〈 0. 05 ）. There was no significant difference in the changes of platelet and albumin before and after surgery. 7 patients （7/16, 43.8% ） had one or more complications including 5 cases （31.3%） of portal vein thrombosis, massive ascites in 4 cases （25.0%） , 1 case （6. 3% ） of pulmonary infection and 1 case （6. 3% ） of wound infection. There was no inhospital mortality and all the 16 cases were followed up with no shunt anastomotic stenosis as showed by enhanced CT scan, meanwhile postoperative re-bleeding occurred in 1 case （6. 3% ） and 1 case （6. 3%） died from liver failure. Conclusions Distal splenorenal shunts provides an effective method for the treatment of portal hypertension.
出处
《中华普通外科杂志》
CSCD
北大核心
2017年第2期101-104,共4页
Chinese Journal of General Surgery
关键词
高血压
门静脉
脾肾分流术
外科
Hypertension, portal
Splenorenal shunt, surgical
