带蒂脾段后腹膜固定术在门静脉高压症外科治疗中的应用

摘要

Objective To evaluate the clinical feasibility and effectiveness of subtotal splenectomy with retroperitoneal splenic transposition for portal hypertension. Methods Forty four patients with posthepatitic cirrhosis, portal hypertension and hypersplenism were assigned to two groups, 24 patients underwent subtotal splenectomy with retroperitoneal splenic transposi-tion (study group) and 20 patients underwent total splenectomy(control group). Operation time, intraoperative bleeding, length of hospital stay, postoperative complications, peripheral blood cell counts and immunological parameters (CD4, CD8, CD4/CD8) were compared between groups. Results Operation time and postoperative complication rate were significantly lower in study group than those in control group (P<0.05). The white blood cellcount in study group was lower than that in control group at d10 and d60 after operation (P<0.05), and the platelet count was significantly lower in study group than that in control group at d3, d10 and d60 after operation (P<0.05). The CD4 and IgG level in study group were significantly higher than those in control group at d10 after operation (P<0.05);the CD4, CD4/CD8 ratio and the levels of IgA and IgM in study group were significantly higher, and the CD8 was significantly lower than those in control group at d60 after operation(P<0.05). Conclusion Subtotal splenecto-my with retroperitoneal splenic transposition is a preferable surgical procedure, which retains part of the spleen function and avoids postoperative pylethrombosis. Besides, this method also possesses the long- term effects of decompression shunt, and therefore is technical y safe and feasible.%目的：评价带蒂脾段后腹膜固定术治疗门静脉高压症的临床应用可行性及疗效。方法选择肝炎后肝硬化、门静脉高压症、脾功能亢进患者44例，其中行带蒂脾段后腹膜固定术24例（观察组），行全脾切除术20例（对照组）。比较两组患者手术时间、术中出血量、术后住院时间及术后并发症发生情况，以及周围血象（白细胞计数、血小板计数）、免疫功能指标（CD4、CD8、CD4/CD8）等。结果观察组手术时间明显短于对照组、术后并发症发生率明显低于对照组（均P＜0.05）；观察组术后10d、术后2个月白细胞计数均明显低于对照组（均P＜0.05），术后3、10d及术后2个月血小板计数均明显低于对照组（均P＜0.05）；观察组术后10d CD4比例及IgG含量均明显高于对照组（均P＜0.05），术后2个月CD4比例、CD4/CD8及IgA、IgM含量均明显高于对照组（均P＜0.05），CD8比例明显低于对照组（P＜0.05）。结论带蒂脾段后腹膜固定手术是一种较好的保脾手术方式，保留了脾脏的部分或大部分功能，避免了术后门静脉血栓的发生，并且远期具有分流作用，技术上是安全可行的。