失代偿期乙型肝炎肝硬化患者行脾切除术与脾动脉部分栓塞术治疗疗效观察

摘要

目的：观察失代偿期乙型肝炎肝硬化患者行脾切除术或脾动脉部分栓塞术的疗效。方法选择我院2010年2月～2013年2月收治的采用脾切除术治疗的失代偿期乙型肝炎肝硬化患者50例和采用脾动脉部分栓塞术治疗的失代偿期乙型肝炎肝硬化患者28例。另选择我院同期收治入院的采用常规保守治疗的患者30例作为对照组。结果随访3组患者治疗后1年，对照组外周血白细胞和血小板计数分别为（3.3±0.6）×109/L和（56.3±5.8）×109/L，显著低于脾切除组（6.2±0.6）×109/L和（126.5±12.7）×109/L（P<0.05），或脾动脉栓塞组（7.2±0.8）×109/L和（112.8±10.6）×109/L（P<0.05）；对照组 CD4、CD4/CD8比值和白蛋白分别为（32.5±3.5）%、（1.1±0.2）和（24.9±3.8） g/L，显著低于脾切除组（41.8±4.2）%、（1.9±0.2）和（29.1±3.7） g/L（P<0.05），或脾动脉栓塞组（41.6±4.9）%、（1.7±0.2）和（28.2±4.0） g/L（P<0.05），而CD8、TBIL、ALT、PT分别为（32.3±4.7）%、（42.7±21.5）μmol/L、（67±35） IU/L、（24.8±3.4） s，显著高于脾切除组（22.7±3.4）%、（29.2±12.4）μmol/L、（40±26） IU/L、（16.2±3.4） s（P<0.05），或脾动脉栓塞组（23.0±3.6）%、（35.2±13.4）μmol/L、（56±20） IU/L、（16.5±2.9）s（P<0.05）；对照组膈下感染、肺部感染、肺不张、脾静脉炎、上消化道出血发生率分别为43.3%、56.7%、26.7%、20.0%、23.3%，显著高于脾切除组的12.0%、14.0%、6.0%、4.0%、8.0%（P<0.05），或脾动脉栓塞组的10.7%、14.3%、3.6%、3.6%、7.1%（P<0.05）。结论脾切除术或脾动脉部分栓塞术后，患者肝功能稳定，不同程度地减少了感染和上消化道出血的发生率。%Objective To observe the efficacy of patients with decompensated hepatitis B cirrhosis after splenectomy or partial splenic artery embolization. Methods 108 patients with decompensated hepatitis B-related liver cirrhosis were recruited in this study,and 50 received splenectomy,28 received partial splenic artery embolization and 30 received conventional medical therapy as control. Results At the end of one-year follow-up,the peripheral white blood cell and platelet counts in control group were(3.3±0.6)í109/L and(56.3±5.8)í109/L, significantly lower than in spleen resection group(6.2±0.6)í109/L and(126.5±12.7)í109/L(P<0.05),or in partial splenic artery embolization group(7.2±0.8)í109/L and (112.8±10.6)í109/L(P<0.05);the peripheral blood CD4,CD4/CD8 ratio and albumin levels were (32.5±3.5)%,(1.1±0.2)and (24.9±3.8) g/L,significantly lower than in patients with splenectomy (41.8±4.2)%,(1.9±0.2) and (29.1±3.7) g/L (P<0.05),or in with partial splenic artery embolization (41.6±4.9)%,(1.7±0.2) and (28.2±4.0) g/L (P<0.05);the CD8,bilirubin,ALT and prothrombin time were(32.3±4.7)%,(42.7±21.5)μmol/L,(67±35) IU/L and(24.8±3.4)s,significantly higher than in spleen resection group(22.7±3.4)%,(29.2±12.4)μmol/L,(40±26) IU/L and (16.2±3.4)s(P<0.05),or in with partial splenic artery embolization (23.0±3.6)%,(35.2±13.4)μmol/L,(56±20) IU/L and (16.5±2.9)s (P<0.05);the incidences of subphrenic infection,pulmonary infection,pulmonary atelectasis,splenic vein inflammation,upper gastrointestinal bleeding were 43.3%,56.7%,26.7%,20.0%,23.3%,significantly higher than in spleen resection group (12.0%, 14.0%,6.0%,4.0%,8.0%,P<0.05),or in with partial splenic artery embolization (10.7%,14.3%,3.6%,3.6%,7.1%, P<0.05). Conclusion The liver function improves in patients with liver cirrhosis after receiving splenectomy or partial splenic artery embolization.