脾脏切除对肝硬化门脉高压患者免疫功能的影响及疗效分析

目的研究贲门周围血管离断术联合脾脏切除术在肝硬化门脉高压症合并脾功能亢进治疗中的临床疗效，以及术后对患者体液免疫功能的影响。方法对54例肝硬化门静脉高压症并食管胃底静脉曲张、脾功能亢进的患者，行贲门周围血管离断联合脾脏切除术，观察患者手术前后与随访期间血细胞、肝功能、免疫球蛋白与补体C3变化以及并发症、死亡率、再出血率。结果术后患者血白细胞及血小板明显升高，随访期间疗效持久稳定；术后监测患者免疫球蛋白变化不明显；随访1年期间患者再出血率为5．56％，病死率为3．7％。结论肝硬化失代偿期患者行脾脏切除术加断流术后能有效降低门静脉压力，彻底治疗脾功能亢进，使感染及上消化道出血等并发症得到控制，肝功能得到稳定，而且脾脏切除后对体液免疫无不良影响。

Effect of splenectomy in the treatment of portal hypertension and the influence of humoral immune function after splenectomy

Objective To study the effect of extensive esophagogastric devascularization plus splenectomy in the treatment of portal hypertension and the influence of humoral immune function after splenectomy. Methods The changes of blood cell, liver functions, immunoglobulin, complement 3, the incidence of rebleeding and the rate of death and complications were observed among 54 cases of portal hypertention. Results All procedures and operations were successful and the improvement of splenemagly was remarkable. The immunoglobulin and complement 3 did not change after operation. The rate of death was 3.7% and the rate of rebleeding was 5.56% after splenectomy for the patients in following-up one year. Conclusion Extensive esophagogastric devascularization plus splenectomy is safe, reasonable and effective for liver cirrohosis portal hypertention combined with hypersplenism. Splenectomy has no effect on humoral immune function and remedial splenectomy is reasonable.