保留脾脏的选择性断流联合脾肾静脉桥式分流术对门静脉高压症患者免疫功能的影响

The Effect of Spleen Preserving Selective Devascularization Combined with Spleno-renal Shunt Bridge on Immune Functions of Patients with Portal Hypertension

目的探讨保留脾脏的选择性断流联合脾肾静脉桥式分流术对门静脉高压症(PHT)患者免疫功能的影响。方法 22例门静脉高压症患者随机分为两组,分别施行保留脾脏的选择性断流联合脾肾静脉桥式分流术(联合组)和切除脾脏的贲门周围血管离断术(对照组),观察两组患者围术期免疫球蛋白(IgG、IgA、IgM)及T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)数量。结果术后4周联合组IgM明显高于对照组(P<0.05),IgG和IgA比较两组差异不明显(P>0.05)。对照组CD4+和CD4+/CD8+术后明显降低(P<0.05),两组术后CD4+、CD4+/CD8+比较差异明显(P<0.05)。结论保留脾脏的选择性断流联合脾肾静脉桥式分流术治疗PHT可有效改善术后免疫功能。

Objective To study the effect of spleen preserving selective devascularization com- bined with splenorenal shunt bridge on immune functions of patients with portal hypertension. Methods 22 patients with portal hypertension were randomly divided into two groups which were respectively treated with spleen preserving selective devascularization operation combined splenorenal shunt bridge （ combined group） and resection of the spleen of pericardial devascu- larization （control group）. Then the patients＇ perioperative immune globulin （ IgG, IgA and IgM） and T lymphocyte subsets （CD4＋, CD8＋ and CD4＋/CD8＋） were observed.Reselts After 4 weeks, the IgM in combined group was higher than that of control group （P〈0.05）. After com- parison between the two groups, the IgG and IgA had no significant difference （P〉0.05）. After operation,the CD4＋ and CD4＋/CD8＋ in the control group decreased significantly （P〈0.05） and the difference of CD4＋, CD4＋/CD8＋in the two groups was significant （P〈0.05）.Conclusion The spleen preserving selective devascularization combined with splenorenal shunt bridge can im- prove the immune functions of postoperative patients with portal hypertension.