门静脉高压病理脾切除疗效分析与远期随访

Short- and long-term outcome analysis of pathologic splenectomy for portal hypertension

目的 通过总结病理脾切除术后对机体的远近期影响 ,从临床角度探讨病理脾有无保留的价值。方法 统计分析 12 0例门脉高压病理脾切除术后的近期疗效及 1～ 10年的远期随访 ,重点了解术后感染的发生、肝癌的形成、肝功能改变及乙型肝炎的发作状况 ,结合文献资料和相关基础研究成果 ,比较手术前后有关指标的差异以及与外伤脾切除远期随访结果的不同。结果 门脉高压病理脾切除后 ,受损的肝功能得以改善 ;无明显的严重感染发生 ;肝炎后肝硬化的病例未见有继发肝癌发生。结论 对病理性脾脏 ,尤其是门脉高压性巨脾正确的处理方法是手术切除而不应当盲目保留。

Objective To determine the value of preserving the pathologic spleen by observing the short-term outcome and long-term follow-up of patients underwent splenic resection because of splenomegaly. Methods The hospitalization data and 1- to 10-year follow-up data of 120 patients underwent splenic resection were reviewed. The reviewed parameters included the occurrence of postoperative infection, hepatic cancer development, changes in liver function and episodes of hepatitis. Meanwhile, the differences in these parameters before and after the operation and those from the results in patients underwent splenic resection for splenic injury were determined according to the data reported in literature and those of our relative basic researches. Results After resection of the pathologic spleen, the functions of the injured liver were partially improved and no severe infection occurred. Furthermore, no case of liver cancer secondary to post-hepatitis cirrhosis was found. Conclusions The pathologic spleen, especially that of cirrhotic splenomegaly, should be resected rather than be preserved.