肝硬化基础的腹部脏器疾病外科手术治疗时脾功能亢进的处理

Surgical treatment of hypersplenism combined with abdominal viscera disease with accompanying liver cirrhosis

目的探讨脾动脉阻断下脾脏微波消融联合腹腔病变脏器切除治疗脾肿大伴脾功能亢进合并其它疾病的临床安全性及近期疗效。方法回顾分析我院16例肝炎肝硬化后脾功能亢进合并其他疾病行脾动脉阻断下脾脏微波消融联合其它腹腔病变脏器切除患者的临床资料。结果 16例患者手术均成功,术后高热4例,左侧胸腔积液8例,脾脏包膜下血肿1例,腹腔渗血1例,皮肤组织淤血2例;未发生脾脓肿、脾脏破裂、顽固性胸腹水、门静脉血栓等,所有患者顺利出院;术后两周及术后一月白细胞、血小板较术前明显升高,且有统计学意义。结论脾动脉阻断下脾脏微波消融联合腹腔病变脏器切除治疗脾肿大伴脾功能亢进合并其它疾病安全,近期疗效显著;

Objective Investigate the security and curative effect of microwave ablation of spleen under occlusion of the splenic artery combined with other abdominal diseased organ resection for treatment of splenomegaly and hypersplenism complicated with other diseases in the near future.Methods Retrospectively analysis of clinical characteristics of 16 patients treated with microwave ablation of spleen under occlusion of the splenic artery combined with other abdominal diseased organ resection who was suffer from hypersplenism secondary to hepatitis cirrhosis complicated with other diseases.Results Operation of the 16 patients were successfully completed,Complications included high fever（4 cases）、left pleural effusion（8 cases）;spleen hematoma（1 case）、abdominal blood oozing（1 case）、skin congestion（2 cases）;No severe complications,such as spleen abscess,spleen rupture,refractory ascites and pleural effusion,portal vein thrombosis,thermal injury of the surrounding organs developed after operative;all patients recovered successfully and discharged;the count of white blood cell,blood platelet increased significantly compared with preoperative after two weeks and one month.Conclusions Microwave ablation of spleen under occlusion of the splenic artery combined with other abdominal diseased organ resection for treatment of splenomegaly and hypersplenism complicated with other diseases was safe and has excellent curative effect in the near future.