肝硬化门静脉高压症并发脾动脉盗血综合征患者脾切除联合贲门周围血管离断术后门脉血流动力学的变化*

目的 研究肝硬化门静脉高压症并发脾动脉盗血综合征患者脾切除联合贲门周围血管离断术后门脉系统血流动力学的变化。方法 2015年2月~2017年2月我院收治的肝硬化门静脉高压症并发脾动脉盗血综合征患者84例,随机分为手术组42例和内科治疗组42例,采用脾切除联合贲门周围血管离断术治疗,另一组采用内科治疗。使用超声检测门静脉血流量（PVF）、门静脉直径（PVD）、门静脉流速（PVV）、脾静脉血流量（SVF）、脾静脉内径（SVD）和脾静脉流速（SVV）。结果 治疗前,两组门脉系统血流动力学指标差异无统计学意义（P>0.05）,在治疗后2 w,手术组PVD、PVF、PVV、SVD、SVF、SVV分别为（1.3±0.3） cm、（786.2±85.1） ml、（49.6±6.7） cm/s、（1.3±0.2） cm、（310.1±49.3） ml和（26.5±8.2） cm,与内科治疗组的（1.6±0.4） cm、（848.1±94.6） ml、（40.1±6.5） cm/s、（1.4±0.3） cm、（377.2±55.2） ml和（19.8±7.2） cm比,差异有统计学意义（P<0.05）; 手术组外周血白细胞计数为（7.7±3.2）×10⁹/L,血小板计数为（252.1±69.3）×10⁹/L,均显著高于内科治疗组的（3.1±1.9）×10⁹/L和（47.2±7.4）×10⁹/L（P<0.05）;手术组肝功能改善也显著优于内科治疗组。结论 采用脾切除联合贲门周围血管离断术可以有效治疗肝硬化门静脉高压症并发脾动脉盗血综合征患者,能显著改善患者门脉血流动力学、外周血细胞和和肝功能指标,其远期疗效还有待于进一步观察。

Changes of hemodynamics after splenectomy combined with pericardial devascularization in patients with cirrhotic portal hypertention complicated by splenic artery steal syndrome

Objective To investigate the changes of hemodynamics after splenectomy combined with pericardial devascularization in patients with cirrhotic portal hypertention complicated by splenic artery steal syndrome. Methods 84 patients with cirrhotic portal hypertension and splenic arterial blood theft syndrome were admitted to our hospital between February 2015 and February 2017,and 42 received splenectomy combined with pericardial vascular devascularization,while another 42 received conventional supporting therapy. The portal vein flow （PVF）,portal vein diameter（PVD）,portal vein velocity （PVV）,spleen venous flow （SVF）,splenic vein diameter （SVD） and splenic venous velocity （SVV） were obtained by ultrasonography. Results At admission,there were no significantly differences as respect to the portal hemodynamic indexes between the two group （P>0.05）,while two weeks after the treatment,the PVD,PVF,PVV,SVD,SVF and SVV in patients receiving surgery were（1.3±0.3cm） cm,（786.2±85.1） ml,（49.6±6.7） cm/s,（1.3±0.2） cm,（310.1±49.3） ml and（26.5±8.2） cm,improved significantly as compared to（1.6±0.4） cm,（848.1±94.6） ml,（40.1±6.5） cm/s,（1.4±0.3） cm,（377.2±55.2） ml and （19.8±7.2） cm in the control,respectively（P<0.05）;the white blood cell and platelet counts in patients receiving surgery were （7.7±3.2）×10⁹/L and （252.1±69.3）×10⁹/L,much higher than （3.1±1.9）×10⁹/L and （47.2±7.4）×10⁹/L（P<0.05）,respectively,in the patients receiving conventional supporting treatment;The liver function tests in patients receiving surgery improved more efficiently. Conclusion Application of splenectomy combined with pericardial devascularization in dealing with cirrhotic portal hypertention complicated by splenic artery steal syndrome is efficacious,but the long-term effect should be investigated in the future.