脾动脉结扎联合贲门周围血管离断术治疗门静脉高压症脾功能亢进

目的探讨脾动脉结扎联合贲门周围血管离断术治疗门静脉高压症脾功能亢进的安全性和有效性。方法2012年2月至2014年1月前瞻性研究对比脾动脉结扎和脾切除联合贲门周围血管离断术治疗42例脾功能亢进患者的疗效。结果术前两组白细胞计数、血小板计数、白蛋白计数、总胆红素、凝血酶原时间、平均年龄和术中平均出血量差异均无统计学意义。术后两组白细胞计数和血小板计数均有改善，脾动脉结扎组上升速度相对平缓；术后门静脉压力下降程度类似；脾动脉结扎组门静脉系统血栓形成概率小于脾切除组（4／19与11／23，P〈0．05），脾动脉结扎组出现3例局灶性脾梗死，经保守治疗后均好转。两组均无死亡病例。结论脾动脉结扎联合贲门周围血管离断术可以作为脾功能亢进的一种安全有效的治疗手段，但其长期效果仍有待进一步观察。

Efficacies of splenic artery ligation pins pericardial devascularization for hypersplenic patients with portal hypertension

Objective To assess the safety and efficacies of splenic artery ligation plus pericardial devascularization in improving hypersplenism in patients with portal hypertension. Methods Between February 2012 and January 2014, 42 patients with cirrhotic hypersplenism caused by portal hypertension were divided non-randomly into 2 groups. Nineteen （male 13, female 6） patients underwent splenic artery ligation plus pericardia] devascularization （SAL group） while another 23 （male 15, female 8） splenectomy plus pericardial devascularization （SE group）. And the outcomes of two groups were compared. Results Preoperative white blood cell （WBC）, platelet counts （PLT）, albumin, to- tal bilirubin, prothrombin time, mean age and intraoperative blood loss volume were similar in two groups. The postoperative levels of Wt3C and PLT in SAL group increased more gently than that of SE group. Portal vein pressure decreased analogously in two groups. The incidence of portal venous system thrombosis in SAL group was lower than that of SE group （4/19 vs 11/23, P~0. 05）. Focal splenic infarction developed in 3 patients in SAL group. All patients recovered with conservative meas- ures. And there was no operatiw~ mortality. Conclusions Splenic artery ligation plus pericardial de- vascularization is both safe and efficacious for hypersplenism. However its long-term outcomes should be determined over longer follow ups.