脾切除加断流术对肝硬化上消化道出血患者预后的影响

目的探讨脾切除加断流手术对肝硬化门脉高压症上消化道出血患者预后的影响。方法 596例肝硬化门脉高压引起的上消化道出血患者分为脾切组(332例)和非脾切组(264例);对270例乙肝后肝硬化患者按Child-Pugh分为A级(72例)、B级(146例)和C级(52例),分析其病死率和再出血时间。结果整体资料的脾切组病死率5.30%,低于非脾切组的16.27%(P<0.01)。乙型肝炎后肝硬化上消化道出血患者中,脾切组(137例)病死率2.19%,低于非脾切组(133例)的12.78%,且再出血时间较非脾切组延长(39.28±24.75)个月vs.(14.83±11.82)个月](P<0.01)。Child A和B级患者脾切组病死率低于非脾切组(2.6%vs.11.4%)(P<0.05)。结论脾切除术加断流术可明显降低肝硬化门脉高压症所致上消化道出血患者的病死率,延长再出血时间。

Effect of splenectomy plus paraesophagogastric devascularization on the outcomes of patients with upper gastrointestinal hemorrhage caused by cirrhotic portal hypertension

Objective To investigate the therapeutic effect of splenectomy plus paraesophagogastric devascularization on the outcomes of patients with upper gastrointestinal hemorrhage caused by cirrhotic portal hypertension.Methods A total of 596 cases was divided into two groups of A(332 cases,underwent splenectomy) and B(264 cases,without splenectomy),of whom 270 cases were divided into Child-pugh class A(72 cases),B(146 cases) and C(52 cases).The mortality and rebleeding time were compared.Results The mortality was lower in group A than that in group B(5.30% vs.16.27%)(P<0.01).In HBV cirrhosis patients,the mortality was lower in those underwent splenectomy(137 cases) than that in those without splenectomy(133 cases)(2.19% vs.12.78%),and the rebleeding time was prolonged(39.28±24.75) months vs.(14.83±11.82) months](P<0.01).In HBV cirrhosis patients with Child-pugh class A and B,the mortality was lower in those underwent splenectomy than that in those without splenectomy(2.6% vs.11.4%)(P<0.05).Conclusion Splenectomy plus paraesophagogastric devascularization can obviously decrease the mortality and extend the rebleeding time in the patients with upper gastrointestinal hemorrhage caused by cirrhotic portal hypertension.