酒精性肝硬化脾切除联合贲门周围血管离断术对肝功能的影响

Impact of splenectomy with periesophagogastric devascularization on liver function of patients with alcoholic cirrhosis

目的探讨脾切除联合贲门周围血管离断术对酒精性肝硬化患者肝功能及肝功能储备的影响。方法选择天津市第二人民医院2009年6月至2013年1月收治的32例酒精性肝硬化、肝功能Child·Pugh B级的门静脉高压症患者,分别于断流术前后测定吲哚氰绿实验肝脏排泄情况(ICGR15)、胆碱酯酶(CHE)等肝储备功能指标及谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清白蛋白(ALB)、凝血酶原时间(PT)、总血清胆红素(TBIL)等肝功能指标。结果患者术后3个月及6个月肝功能明显改善并保持稳定,差异有统计学意义(P<0.05)。肝储备功能术后2周恢复术前水平,术后3、6个月较术前明显改善,差异有统计学意义(P<0.05)。结论脾切除联合贲门周围血管离断术能明显改善酒精性肝硬化患者远期肝功能,增强肝功能储备,且保持长期稳定,减少再次入院治疗机率。

Objective To investigate the effects of splenectomy plus esophagogastric devascularization on hepatic functional reserve and liver function of patients with alcoholic cirrhosis. Methods 32 cases of Child Pugh class B alcoholic liver cirrhosis with portal hypertension were selected for the study. The platelet counts and hepatic functional reserve markers, cholinesterase, ICGR 15（indocyaninegreen retention rate at 15 minutes）, alanine transaminase（ALT）,aspertate aminotransferase（AST）,serum albumin（ALB）, prothrombin time（PT）, total bilirubin（TBIL） and total cholesterol before and after surgery were analyzed. Results Liver function improved at 3 and 6 months（P 〈0.05）.Hepatic functional reserve recovered to preoperative condition in 2 weeks postoperation and obviously improved at 3 and 6 months postoperation（P 〈0.05）. Conclusion Splenectomy plus devascularization could improve hepatic functional reserve, and liver function.