脾切除贲门周围血管联合术对肝硬化门静脉高压症患者凝血功能的影响

摘要

Objective To determine platelet count (PLT),mean platelet volume (MPV),and hemodynamic changes in patients with cir-rhotic portal hypertension (CPH)post splenectomy plus pericardial devascularization (SPPD),and to assess the surgical effect on coagula-tion function.Methods A retrospective analysis was performed on 83 CPH patients undergoing SPPD in our hospital from January 2008 to December 2012.Results Compared with preoperative levels,postoperative portal venous pressure decreased,blood flow was reduced,and portal vein diameter was significantly reduced;additionally,postoperative hepatic artery diameter was increased,and hepatic artery blood flow increased.Blood alanine aminotransferase,albumin,total protein,and fibrinogen levels,thrombin time,and MPV did not significantly change 30 days postoperatively versus 7 days preoperatively(P>0.05 );the corresponding total bilirubin,activated partial thromboplastin time and prothrombin time relatively declined(P<0.05),whereas PLT and prothrombin time activity increased(P<0.05).There was a significant increase in PLT (P<0.05)but no significant change in MPV 30 days postoperatively versus 7 days preoperatively (P>0.05). Conclusion SPPD can significantly improve liver functional reserve and coagulation function in patients with CPH.%目的：分析脾切除贲门周围血管联合手术后，肝硬化门静脉高压症患者血小板数量、平均体积和血流动力学的改变，探讨其对凝血功能的影响。方法选取中国人民解放军第四军医大学第二附属医院2008年1月至2012年12月经脾切除贲门周围血管联合手术治疗的肝硬化门静脉高压症患者83例进行回顾性分析。计量资料组间比较采用配对t检验。结果手术后门静脉压力较术前下降，血流量变小，门静脉内径显著变窄；术后肝动脉内径变宽，肝动脉血流量增加。术后30 d ALT、白蛋白（Alb）、总蛋白（TP）、纤维蛋白原（FIB）、凝血酶时间（TT）以及血小板平均体积（MPV）值较术前7 d无明显变化（P＞0.05），而TBil、部分活化凝血酶（APTT）和凝血酶原时间（PT）3项指标有所下降（P＜0．05）；血小板（PLT）及凝血酶原时间活动度（PTA）上升（P＜0．05），术后30 d与术前7 d相比较，患者PLT数量显著增加（P＜0．05），但MPV无显著改变（P＞0．05）。结论脾切除贲门周围血管联合手术能够明显改善肝硬化门静脉高压症患者肝脏功能储备及凝血功能。