消灭血吸虫病地区血吸虫病性肝硬变患者30年回顾性调查

30-YEAR RETROSPECTIVE STUDY OF SCHISTOSOMAL CIRRHOSIS OF THE LIVER IN AN AREA AFTER SCHISTOSOMIASIS CONTROL

10年前血吸虫病已控制的上海市郊洞泾乡383例血吸虫病性肝硬变30年回顾性调查,从生存曲线,发现11～30年前切脾的243例1～30年的生存率均明显高于同时期未切脾的140例患者。术后(或初诊后)75％存活的年限,切脾、未切脾组分别为18和4年;30岁内切脾患者(27年)明显较长于31～40(18年)、41～50(17.5年)和50岁以上手术者(12年);巨脾型切脾(19.5年)明显较长于腹水型切脾患者(10.5年)。上消化道出血、腹水等并发症和病死率切脾组明显低于未切脾组,表明脾切除不仅能防止门脉高压并发症,且能增强体质减少其他疾病。死亡患者平均年龄与当地居民预期寿命相比,切脾组、未切脾组无差别,不少未切脾者寿命无明显缩短。

The natural history of 383 patients of schistosomal cirrhosis, discovered from 1960-1990 in Donjing township Shanghai suburb, where schistosomiasis had been controlled for more than 10 years, was studied. The cumulative survival rate in 243 patients who had splenecto-my 11-30 years previously (group I ) was much higher than that of 140 patients without splenectomy (group II ), and the time for 75% survival rate of these 2 groups were 18 and 4 years respectively, being much longer in the splenectomized patients without ascites and those operated before age of 30 than those complicated with ascites and those operated between the age of 31 - 50 or after 51 years of age. The complications and mortality rate of group I were significantly lower than that of group I , indicating that splenectomy not only prevented the complication of portal hypertension but improved the general health and resistance of the patients against other pathogens as well. There was no significant difference between group I and group II in the ratio of the avarage death age of the deceased patients to the life expectancy of the general population, suggesting that the life span of a number of patients without splenectomy are not substantially shortened in an area where schistosomiasis had been controlled.