改良脾-肺固定术治疗门静脉高压症并上消化道出血

Curative effect of modified splenopneumopexy treatment on portal hypertension

目的探讨改良脾-肺固定术治疗门静脉高压症的疗效。方法观察门静脉高压症患者行改良脾．肺固定术后不同时期白细胞、血小板，血清补体（C3、C4）、淋巴细胞亚群（CD4、CD8）及门静脉系统血流动力学的变化，并与术前作统计学分析。结果改良脾-肺固定术术后6个月白细胞由（3．27±1．93）×10^9／L上升至（6．70±2．12）×10^9／L，血小板由（77．60±44．14）×10^9／L上升至（164．00±66．78）×10^9／L；C3含量由（0．83±0．06）g/L上升至（1．03±0．15）g／L，C4含量由（0．12±0．02）g/L上升至（0．16±0．02）g/L，CD4由（25．07±5．35）％上升至（31．18±5．26）％，CD4／CD8由（1．74±0．25）上升至（2．03±0．36）；自由门静脉压由（43．92±5．50）cmH，0（1cmH2O=0．098kPa）降至（33．92±5．50）cmH2O，与术前比较差异均有统计学意义（P〈0．05）；术后6个月彩色多普勒超声显示脾一肺间侧支循环形成。结论改良脾一肺固定术治疗门静脉高压症既能纠正脾功能亢进、维持机体免疫功能，又能降低门静脉压力、预防上消化道出血。

Objective To evaluate the effect of modified splenopneumopexy treatment for portal hypertension. Methods In the patients with portal hypertension in different periods after modified spleno- pneumopexy, the changes in leukocytes, platelets, serum complement, lymphocyte subsets and the hemo- dynamics of portal vein were observed and compared with those preoperation. Results After 6 months, the number of leukocytes was increased from （3.27±1.93 ）×10^9/L to （6. 70±2. 12）×10^9/L and that of platelets from （77. 60±44. 14） ×10^9/L to （164. 00±66. 78 ）×10^9/L, the level of C3 from （0. 83±0.06） g/L to （1.03±0. 15） g/L, C4 from （0. 12±0. 02） g/L to （0. 16 ±0. 02） g/L, the level of CD4 from （25. 07 ±5. 35）% to （31.18±5.26）%, CD4/CD8 from （1.74±0. 25） to （2. 03±0. 36）, while the free portal pressure was decreased from （43.92-＋ 5.50） cm H2O （1 cm H2O= 0.098 kPa） to （33.92 ± 5.50） cm H2O. There were significant differences statistically in above indexes before and after operation （ P 〈 0. 05 ）. Color Doppler ultrasound revealed that formation of the collateral circulation between the spleen and lung 6 months after operation. Conclusion The modified splenopneumopexy for portal hypertension not only can correct hypersplenism and maintain the immunological function, but also lower the pressure of portal vein and prevent hemorrhage of the upper digestive tract.