脾大部切除术治疗肝硬化脾大脾亢的疗效分析

Therapeutic effects of subtotal splenectomy on splenomegaly and hypersplenism due to cirrhosis

目的 探讨脾大部切除术治疗肝硬化脾大脾亢的疗效。方法 对 2 6例肝硬化脾大脾亢病人行脾大部切除加断流术 ,术后 1年内随访 ,观测门静脉压力和直径、外周血细胞计数、骨髓细胞学、血小板相关IgG(PAIgG)及残脾大小的变化。结果 脾大部切除加断流术后 ,门静脉压力下降 ,门静脉直径缩小 ,残脾显像良好 ,无明显增大 ,外周血红细胞、白细胞和血小板计数升高 ,骨髓像大致正常 ,PAIgG下降 ,随访 1年见脾亢明显改善或消失。结论 脾大部切除术治疗肝硬化脾大脾亢疗效可靠 ,术后残脾无明显增大 ,保留略小于正常脾大小的残脾是适宜的。

Objective To evaluate the therapeutic effects of subtotal splenectomy on splenomegaly and hypersplenism due to cirrhosis. Methods Twenty-six patients with splenomegaly and hypersplenism due to cirrhosis were followed up in the first year after subtotal splenectomy plus pericardial devascularization. B type ultrasonic examination and γ-scintigraphy were carried out. The changes in portal venous pressure and diameter, peripheral blood cell counting, myelogram, platelet-associating immunoglobulin G (PAIgG), the size and function of residual spleen were observed. Results After operation, the portal venous pressure and diameter were reduced, the residual spleen showed a well image and did not enlarge, peripheral RBC, WBC and platelet were increaed, myelogram was approximately normal and PAIgG significantly was decreased. The follow-up data in the first year after operation indicated that hypersplenism disappeared or took an obvious turn for the better. Conclusion The therapeutic effects of subtotal splenectomy on splenomegaly and hypersplenism due to cirrhosis are reliable. The residual spleen will not enlarge any more after operation. Meanwhile it is reasonable to preserve the residual spleen a little smaller than normal spleen.