1118例开腹脾切除断流术治疗门静脉高压症术后并发症及生存分析

摘要

目的 探讨门静脉高压症患者开腹脾切除断流术后近期和远期并发症的发生情况.方法 按人组标准选取解放军第三○二医院外科2010年4月至2015年9月完成的1 118例开腹脾切除断流术的患者资料,于2016年10月集中进行回顾性病例调查及电话随访.患者术前均有上消化道出血史.近期并发症包括腹腔内出血二次开腹、严重感染、进食障碍、肝功能不全、术后近期门静脉血栓及围手术期死亡例数;远期情况包括术后上消化道再出血、术后生存率、术后恶性肿瘤发生率.应用GraphPad Prism 5软件进行数据生存分析及图表绘制.结果 1 118例患者的术后近期并发症:腹腔内出血二次开腹21例(1.8％),严重感染32例(2.9％),进食障碍11例(1.0％),肝功能不全18例(1.6％),术后门静脉血栓形成526例(47.1％),围手术期死亡5例(0.5％).942例患者获得完整的远期生存随访资料,术后1、3、5年上消化道再出血率为4.4％、12.1％、17.2％;1、3、5年术后生存率为97.0％、93.5％、90.3％;1、3、5年术后恶性肿瘤发生率为1.7％、4.4％、6.2％.结论 合理选择门静脉高压症的手术适应证及时机、正确把握手术流程和有效的围手术期管理直接关系到患者的近期预后.脾切除断流术能够降低患者上消化道再出血率,改善生存率,且不增加恶性肿瘤发生率.%Objective To analyze the recent postoperative and long-term postoperative complications of open-splenectomy and disconnection in patients with portal hypertension.Methods There were 1 118 cases with portal hypertension who underwent open splenectomy and azygoportal disconnection from April 2010 to September 2015 at Department of Surgery,People's Liberation Army 302 Hospital.Retrospective case investigation and telephone follow-up were conducted in October 2016.All patients had history of upper gastrointestinal bleeding before operation.Short-term complications after surgery were recorded including secondary laparotomy of postoperative abdominal hemostasis,severe infection,intake disorders,liver insufficiency,postoperative portal vein thrombosis and perioperative mortality.Long-term data including postoperative upper gastrointestinal rebleeding,postoperative survival rate and incidence of postoperative malignancy were recorded,too.GraphPad Prism 5 software for data survival analysis and charting.Results Postoperative short-term complications in 1 118 patients included secondary laparotomy of postoperative abdominal hemostasis (1.8％,21/1 118),severe infection (2.9％,32/1 118),intake disorders(1.0％,11/1 118),liver dysfunction (1.6％,18/1 118),postoperative portal vein thrombosis (47.1％,526/1 118) and perioperative mortality (0.5％,5/1 118).After phone call following-up,942 patients' long-term data were completed including 1,3,5 years postoperative upper gastrointestinal rebleeding rate (4.4％,12.1％,17.2％),1,3,5-year postoperative survival rate (97.0％,93.5 ％,90.3％);the incidence of postoperative malignant tumors in 1,3 and 5 years were 1.7％,4.4％ and 6.2％.Conclusions Reasonable choosing of surgical indications and timing,proper performing the surgery process,effective conducting perioperative management of portal hypertension are directly related to the patient's short-term prognosis after portal hypertension.Surgical intervention can reduce the rates of patients with upper gastrointestinal rebleeding,improve survival,and do not increase the incidence of malignant tumors.