肝炎后肝硬化门静脉高压性脾肿大患者脾切除术前外周血细胞减少与手术疗效的关系

摘要

目的：探讨肝炎后肝硬化门静脉高压性脾肿大病人外周血细胞减少与手术疗效，阐明肝炎后肝硬化门静脉高压性脾肿大病人脾切除术后何种外周血细胞减少与手术疗效的关系最为密切。方法选择肝炎后肝硬化门静脉高压性脾肿大病人366例。根据术前血细胞的减少，分为单种血细胞减少组，两种血细胞减少组和多种血细胞减少组；手术前后与随访期间检测血细胞。全组均行切除脾脏＋贲门周围血管离断术。运用 SPSS13．0统计软件，单因素比较采用K-W秩和检验进行数据处理，多单因素比较采用多元线性回归分析，P＜0．05为显著性差异。结果术后患者血白细胞及血小板明显升高，随访期间疗效持久稳定；术后监测患者免疫球蛋白升高明显；随访1，2年期间患者再出血率明显减少。在单种血细胞减少组中，只有红细胞组内疗效比较有显著性差异（P＜0．05），但随着病例数的增加，累积的 RBC组内疗效比较又无显著性差异（P＞0．05），而累积的 PLT减少则呈现显著性差异（P＜0．05）。在多种血细胞减少组中，PLT减少与 WBC减少及 RBC减少比较有明显差异（P＜0．05）。术后疗效单种血细胞减少组与多种血细胞减少组比较有明显差异（P＜0．05）。结论外周血细胞减少的程度与疗效有明显关系，单种血细胞减少组的疗效明显优于多种血细胞减少组，PLT减少是影响手术疗效的主要因素，减少越严重疗效越差。%Objective To investigate hepatitis liver cirrhosis portal hypertension patients with splenic enlargement after reduction and peripheral blood cells Surgical curative effect.Methods Between January 1991 and December 1991, the author's hospitals liver cirrhosis portal vein Compressional splenomegaly patients the clinical data of 3 6 6 cases.U-sing SPSS13.0 statistical software,single Factor Compare the K-W rank of testing and data processing,single factor comparison using multivariate linear back more To return analysis,P<0.05 is significant difference.Results Of three types of blood counts are normal 3 6 cases (9.8%),and more than a peripheral blood Cell to reduce 330 cases,of which the single kind of blood cell reduction in 99 cases (30.0%),two kinds of blood cells Less 118 cases (35.8%),three types of blood cells counts were reduced,113 cases (34.2%),the whole group Excision of spleen+door,block or by-pass surgery,in single cells reduce group,only the RBC Curative effect comparison in the group have significant differ-ence (P< 0.05),but with the increase of the number of cases,and accumulated Comparative effectiveness of RBC group and there was no significant difference (P>0.05),and the accumulation of PLT decrease Show significant differ-ence (P<0.05),in a variety of blood cells decrease in the group,the PLT decrease With The WBC and RBC decrease compared with significant difference (P<0.05).A single blood fine curative effect after surgery Cell reduce groups with a variety of blood group had significant difference (P<0.05).Conclusion To reduce the degree of peripheral blood cells have obvious relationship with curative effect,a single blood cell reduction group Curative effect is superior to a variety of blood cell reduction group,the PLT decrease is mainly due to the operation curative effect And reduce the serious effect of the poor.