门静脉高压症脾机能亢进并胆道疾病的外科处理

Surgical management of hypersplenism of portal hypertension accompanied with biliary tract diseases

目的 探讨各种胆道手术在门静脉高压症脾机能亢进状态下 ,先期、同期、后期手术的不同临床特点 ,提出合理的手术方式。方法 回顾性分析我院 1990～ 2 0 0 0年间所收治的 119例并门静脉高压症脾机能亢进的胆道手术 ,其中胆道先期手术 43例 ,胆道与脾机能亢进症同期手术 2 4例 ,胆道后期手术 5 2例。结果 胆道先期与同期手术在术中平均出血量、膈下感染、肝功能、平均住院天数等方面无明显差异 (P >0 .0 5 ) ;胆道后期手术与胆道先期、同期手术比较 ,术中平均出血量、平均住院天数较少 ,肝功能损害较小 (P <0 .0 1) ,膈下感染率较低 (P <0 .0 5 ) ;三组胆道手术死亡率无明显差异 (P >0 .0 5 )。结论 在并门静脉高压症脾机能亢进时 ,胆道后期手术优于胆道先期、同期手术。

Objective To investigate the differences among various operations at the biliary tract due to hypersplenism of portal hypertension and find a reasonable operation. Methods The clinical data of 119 patients with due to hypersplenism of portal hypertension treated in our hospital by operations at the biliary tract between 1999 and 2000 were retrospectively analyzed. Of all the patients, 43 received fore-splenectomy (FS), 24 co-splenectomy (CS) and 52 post-splenectomy (PS). The differences among the three operative approaches in operation bleeding, infection below the diaphragm, liver function, average duration of hospitalization and mortality were determined. Results FS was similar to CS in operation bleeding, infection below the diaphragm, liver function and average duration of hospitalization ( P >0.05). However, the operation bleeding, liver function, average duration of hospitalization and infection below the diaphragm were significantly lower in PS than in FS or CS ( P<0.01, P <0.05). As for mortality, there were no marked differences among the three operative approaches. Conclusions PS is better than FS and CS in treatment of hypersplenism of portal hypertension.