脾次全切除腹膜后移位加断流术治疗门脉高压症的临床研究

A new method of treating portal hypertension by subtotal splenectomy with retroperitoneal splenic transposition and devascularization

目的：探讨一种新的术式以提高肝硬化门脉高压症的疗效．方法：采用脾次全切除腹膜后移位加断流术治疗肝硬化门脉高压症36例，与36例贲门周围血管离断术进行对比研究。随访3个月～5．5年，平均26个月。结果：（1）研究组食管静脉曲张消失11．5％，好转61．5％，无变化26．9％，而对照组好转50．0％，无变化45．8％，加重4．2％，研究组优于对照组（P＜0．05）；（2）研究组脾亢消失；（3）免疫指标（IgM，C3）2年内研究组与对照组相比差异有显著性（P＜0．05）；（4）血管数字减影显示，余脾与腹膜后组织建立了丰富的侧支循环，使门脉血向腹膜后分流．结论：本术式兼有断流术和分流术的优点，是治疗门脉高压症的一种新的术式。

Objectives:To devise a new surgical procedure for approving the operative effectof portal hypertension caused by hepatic cirrhosis. Methods:In treatment group, subtotalsplenectomy with retroperitioneal transposition was performed in 36 cases of cirrhotichypertensives, in contyol group, 36 cases were treated by devascularization. The follow-up periodranged from 3 months to 5.5 years (average 26 months). Results:(1) In the treatment group, therates of disappearance, improvement and absence of changes of esophageal varices were 11.5%,61.5% and 26.9%, respectively, whereas those of the controlled group were:improvement 50%,absence of change 45.8% and aggravation 4.2%, there was a significant difference between them(P<0.05).(2) Furthermore, in the treatment group, hypersplenism disappeared in all. (3) There wasalso significant difference between the two groups in immunological indexes (P<0.05). (4) DSAshowed abundant collateral circulation in the residual spleen and retroperitoneal wall, whichenabled the portal blood flow diverting to retroperitoneal tissues. Conclusions:This method is anew operative approach for portal hypertension which possesses both the advantage ofdevascularization and decompression shunt.