门静脉高压性脾肿大无外周血细胞减少31例报告

Thirty-one cases report of the portal hypertension splenomegaly without peripheral blood hematocytopenia

目的:探讨门静脉高压性脾肿大无外周血细胞减少的发生率及其临床意义。方法:回顾性研究门静脉高压性脾肿大336例的临床资料和术中探查的情况。结果:其中31例(9.2%)均有门静脉高压性脾肿大、食管下段胃底静脉曲张和上消化道出血病史及腹水,但无外周血细胞减少。25例获随访,平均WBC、RBC、PLT、Hb术前与术后差异无统计学意义(P>0.05);骨髓极度增生活跃占84%(21/25)、并可见到幼红细胞,增生活跃和明显增生活跃各占8%(2/25),均经手术治疗,术中测量自由门静脉压力平均33.4cmH2O,脾脏大小平均为23.1cm×16.5cm×9.4cm。结论:外周血细胞减少是门静脉高压性脾肿大的并发症,而不是其必然表现。对无外周血细胞减少的脾肿大治疗,是否需要切除脾脏值得探讨。

Objective： To study the incidence of portal hypertension without peripheral blood hematocytopenia. Methods： A retrospective study was made on clinical data of 336 patients with portal hypertension and their operative situations. Resluts： Thirtyone patients suffered from portal hypertension splenomegaly had moderate and severe suboesophageal fundal varices under barium meal imaging or gastroscope examination and had upper digestive tract bleeding without peripheral blood hematocytopenia. The mean value of WBC, RBC, PLT and Hb were 7.65±3.6 ×10^9/L, 4.64 ±0.61 ×10^12/C ,15.72±4.72 × 10^9/L and 124 ± 14.1 g/L, respectively, marrow analysis showed 84%（21/25） polar proliferation and infantilism erythrocyte at the same time,active proliferation and obvious proliferation was 8%（2/25）, respectively.All patients received operation, in which the mean value of free portal pressure was 33.4cmH2O and the mean size of spleen size was 23.1 cm × 16.5 cm × 9.4 cm. Conclusion： 9.2% of patients with portal hypertension＇s splenomegaly were without peripheral blood hematocytopenia.The necessarity of splenctomy still needs more research.