前白蛋白变化在脾切除治疗肝豆状核变性中临床意义

CLINICAL EFFECT OF PREALBUMIN ON TREATMENT OF HEPATOLENTICULAR DEGENERATION BY SPLENECTOMY

目的观察脾切除治疗肝豆状核变性继发脾亢病人围手术期血清前白蛋白及常规肝功能变化,研究其临床意义。方法观察21例肝豆状核变性继发脾亢病人术前、术后1周、术后2周血清前白蛋白变化和肝功能变化,并探讨与术中有无行脾动脉结扎及其与并发症发生之间的关系。结果术前血清前白蛋白异常发生率高于常规肝功能(P<0．01);术后血清前白蛋白水平波动比常规肝功能明显(P<0．01);行脾动脉结扎比未结扎病人术后肝功能改善较明显(P<0．05);有并发症术前血清前白蛋白比无并发症患者明显降低,术后恢复明显差(P<0．01),常规肝功能变化不明显。结论血清前白蛋白较常规肝功能更敏感地反映肝豆状核变性继发脾亢病人的肝脏损害,动态观察PA值变化有助于了解肝功能损害、把握手术时机并及时发现、处理并发症;如有可能,术中行脾切除前应先结扎脾动脉。

Objective To observe the changes of liver function and prealbumin （PA） in perioperative cases of hepatolenticular degeneration complicated with hypersplenism. Methods Analysis was made in 21 patients with a diagnosis of hepatolenticular degeneration complicated with hypersplenism,comparing the changes of preoperative PA and liver function with postoperative ones. Result In these patients the fluctuation of PA were more significant than the fluctuation of liver function（P〈0.01 ）. The liver function of cases who underground splenic artery ligation improved significantly than the others （P〈0.05）. The level of PA in cases with complications less than no complications ones （P〈0.01）. Conclusion PA can sensitively response the degree of injured liver better than regular liver function. To motional observe the change of PA can help to find out the damage of liver function and help to select operative time, it make easy to find and treat with complications. In condition of possibility,splenic artery ligation should be made in splenectomy.