脾切除联合贲门周围血管离断术对非硬化性门静脉高压患者肝功能及肝纤维化的影响

摘要

目的 观察脾切除联合贲门周围血管离断术对非硬化性门静脉高压症( NCPH)患者肝功能及肝纤维化的影响.方法 回顾性分析2008年4月至2017年12月首都医科大学附属北京佑安医院46例NCPH患者资料.根据治疗方式不同分为观察组(n=16)和对照组(n=30).观察组行脾切除联合贲门周围血管离断术,对照组保守治疗.比较治疗前后两组患者肝功能、腹水、静脉曲张破裂出血及肝纤维化指标的变化,以及观察组治疗前后肝血流的变化.结果 两组治疗前后ALT、AST、总胆红素、白蛋白等比较,差异无统计学意义(P＞0. 05).治疗后6个月内,对照组腹水、出血发生率高于观察组,差异有统计学意义(P＜0. 05).观察组术前10例患者有静脉曲张破裂出血史,治疗后6个月内均未再出血.治疗后观察组Ⅲ型前胶原N端肽[(32. 3 ± 12. 1) g/L比(56. 7 ± 15. 3) g/L]、Ⅳ型胶原[( 46. 6 ± 35. 0 ) g/L 比( 121. 3 ± 30. 4 ) g/L]、层粘连蛋白[( 32. 5 ± 10. 5 ) g/L 比(65. 8 ± 11. 1)g/L]均低于对照组,差异有统计学意义(P＜0. 05).观察组术前门静脉血流量高于术后[(1 056. 8 ± 679. 8)ml/min 比(481. 0 ± 227. 6)ml/min],差异有统计学意义( P＜0. 05).结论 脾切除联合贲门周围血管离断术在不影响NCPH患者肝功能的情况下,可以有效止血,延缓肝纤维化.%Objective To study the impact of splenectomy and devascularization on liver function and liver fibrosis in patients with non-cirrhotic portal hypertension (NCPH). Methods The clinical data of patients with NCPH who were treated in Beijing You'an Hospital of Capital Medical University from April 2008 to December 2017 were retrospectively analyzed. The patients were divided into the observation group (n=16 ) and the control group ( n =30 ) according to their treatment methods. The observation group underwent splenectomy combined with devascularization, while the control group received conservative treatment. The changes in liver function, ascites, varicose vein rupture and bleeding before and after treat-ment, and the changes in liver blood flow before and after treatment in the observation group were compared. Results The before and after treatment of the 2 groups in ALT, AST, total bilirubin, albumin showed no statistically significant difference (P＞0. 05). Six months after treatment, the rates of ascites and bleeding were significantly higher than the observation group, (P＜0. 05). Ten patients who had a history of preoper-ative variceal hemorrhage in the observation group did not bleed within 6 months after treatment. Further-more, in the observation group after treatment when compared with the control group, the PC-Ⅲ [(32. 3 ± 12. 1) g/L vs. (56. 7 ± 15. 3)g/L],Ⅵ-C [(46. 6 ± 35. 0) g/L vs. (121. 3 ± 30. 4)g/L], LN [(32. 5 ± 10. 5) g/L vs. (65. 8 ± 11. 1) g/L] were significantly lower than the control group ( P ＜0. 05). The preoperative portal venous blood flow in the observation group was significantly higher than that after surgery [(1 056. 8 ± 679. 8) ml/min vs. (481. 0 ± 227. 6) ml/min, P＜0. 05]. Conclusion Splenectomy and devascularization effectively stopped variceal bleeding and delayed liver fibrosis in NCPH patients without affecting the liver function.