门脉高压症合并脾功能亢进施行脾切除术的临床疗效分析

目的：分析门脉高压症合并脾功能亢进（简称门脉高压性脾亢）患者行脾切除术的近远期疗效和切脾对机体的影响。方法收集2004年1月至2014年1月收治的351例门脉高压性脾亢患者，回顾性分析病例资料以及行脾切除术后近期疗效评价，并进行远期随访调查，重点了解术后感染、肝癌、肝功能、血细胞变化以及系统疾病的控制情况等。结果患者行脾切除术后，近期内受损的肝功能和血细胞得以恢复。近期内出现黄疸者42例，腹水31例，发热34例，上消化道再出血者13例，予以积极对症处理后均康复出院。远期随访87例发现，29例在切脾约2~33（中位11.4）个月后出现肝功能下降，血清白蛋白水平下降和转氨酶水平升高；原伴发的糖尿病、高血压病和消化系统疾病切脾后较切脾前病情容易控制；继发肝癌者6例，4例死亡，未见有脾切除后凶险性感染。结论门脉高压症合并脾功能亢进患者进行脾切除术对机体有利有弊，故对于此类脾大患者不能一律予以切除。

Clinical efficacy of splenectomy for hypersplenism with portal hypertension

Objective To summarize and analyze the efficacy by observing the short-and long-term follow-up of patients undergoing splenectomy for hypersplenism with portal hypertension. Methods Clinical data of 351 cases was collected involved in portal hypertension and hypersplenism. The reviewed parameters included the occurrence of postoperative infection, emergence of secondary hepatic cancer, changes of liver functions and peripheral blood cells, and the condition control of diabetes mellitus, cardiovascular system and alimentary system diseases. Results After resection of the pathologic spleen, the functions of injured liver and blood cells count gradually improved and recovered to normal levels in a short period. The short-term complications, mainly including 42 cases with jaundice, 31 with ascites, 34 with fever, and 13 with rehaemorrhagia of upper gastrointestinal tract, alleviated by prompt symptomatic treatment. In the long-term follow-up of 87 cases, 29 were detected declined liver functions, decreased serum albumin, and increased transaminase about 2~33（medians 11.4） months postoperatively. 6 cases had a secondary liver cancer, 4 patients died and there was no overwhelming postsplenectomy infection （OPSI）. Furthermore, the condition control of diabetes mellitus, cardiovascular system and alimentary system disease obviously improved after splenectomy. Conclusion Splenectomy has both advantages and shortcomings for patients of hypersplenism with portal hypertension and needs further exploration.