远端脾肾分流术联合脾部分切除治疗门静脉高压症脾功能亢进疗效探讨

Treatment of portal hypertension and hypersplenism by distant splenorenal venous shunt operation combined with partial splenectomy

目的对比研究远端脾肾分流术(Warren术)与远端脾肾分流术联合脾部分切除治疗门静脉高压症脾功能亢进的疗效。方法选取第四军医大学唐都医院2010年以来22例获得完整随访资料的行外科手术治疗的门静脉高压症脾功能亢进病人,其中Warren术组(分流组)8例,Warren术+脾部分切除组(分流+切脾组)14例,比较观察两组术前、术后第7、30天的外周血象主要指标(白细胞、血小板)以及两组术前、术后第30天外周血免疫指标(IgG、IgA、IgM)。结果 Warren术+脾部分切除组病人术后白细胞及血小板恢复指标明显优于Warren术组,差异有统计学意义(P<0.05);外周血免疫球蛋白检测显示两组术后与术前比较差异无统计学意义(P>0.05)。结论 Warren术联合脾部分切除治疗门静脉高压症脾功能亢进疗效优于单纯Warren术。在有效降低门静脉压力前提下很大程度上解决脾功能亢进,又保留了脾脏正常免疫功能。但切除脾脏比例以及适应证等需根据病人制定个体化治疗方案,尤其在切除脾脏比例方面需要进一步研究验证。

Objective To compare the effect of distant splenorenal venous shunt operation （Warren＇ s operation） with distant splenorenal venous shunt operation combined with partial spleneetomy in treating portal hypertension and hypersplenism. Methods The clinical data of 22 cases of portal hypertension and hypersplenism treated by operation with complete follow-up data from 2010 at Tangdu Hospital of the Fourth Military Medical University were analyzed. Twenty-two cases included 8 cases performed distant splenorenal venous shunt operation named Warren group and 14 cases performed distant splenorenal venous shunt operation combined with partial splenectomy named Warren＋ partial splenectomy group. WBC and PLT counts on the 7th and 30th day after surgery and IgG,IgA and IgM on the 30th day after surgery between two group were compared. Results The recovery of WBC and PLT in Warren ＋ partial splenectomy group was better than those in Warren group significantly （P〈0.05）. Pre and postoperative immunoglobulin test showed that there was no significant difference between two groups （P〉0.05）. Conclusion The therapeutic effect of distant splenorenal venous shunt operation combined with partial splenectomy for portal hypertension and hypersplenism is superior to simple distant splenorenal venous shunt operation. The former could both decrease portal pressure and cure hypersplenism with keeping the normal splenic physiological function. However, the proportion of spleen need to be operated on and the indication require individualization. The former need further investigation especially.