肝硬化门静脉高压性外周血细胞减少与手术预后

Liver cirrhosis portal hypertension decreased peripheral blood cells and surgical outcomes

目的 比较腹腔镜与开腹脾切除加贲门周围血管离断术治疗门静脉高压症的临床效果及安全性,探讨腹腔镜脾切除是否增加了门静脉血栓形成的发生率.方法 自2013年1月到2015年12月,有204例病人因诊断为门静脉高压症行腹腔镜或开腹脾切除术.详细收集临床资料并进行回顾性分析,评估临床疗效,并对血栓形成的可能危险因素进行单因素及多因素回归分析.结果 84例病人采用腹腔镜手术,其中18例中转开腹,120例施行开腹手术.完全腹腔镜组（66例）和开腹组（120例）比较,手术时间、术中出血量及输血率相似,腹腔镜组与开腹组术后平均住院时间差异有统计学意义[（11.0±4.0）d比（12.6±5.4）d,P=0.032],两组间术后门静脉血栓形成差异无统计学意义[19例（28.8％）比32例（26.7％）,P=0.756）.脾脏长径≥20 cm、术后住院时间＞10 d是门静脉血栓形成的独立危险因素（P＜0.05）.结论 腹腔镜脾切除术的近期疗效优于传统开腹手术,相对于开腹脾切除术,前者并未增加门静脉血栓的发生率.

Objective To investigate the constituent ratio of peripheral cytopenias in patients with splenomegaly caused by post-hepatitic cirrhotic portal hypertension and potential influence of pe- ripheral cytopenias on prognosis. Methods Between January 1991 and June 2015, 376 cases of post- hepatitic cirrhotic portal hypertension induced splenomegaly patients associated with peripheral cytope- nias, undertook surgery in our hospital, and their clinical data was reviewed. Furthermore, peripheral cytopenias and prognosis in them was graded and compared. Results Patients associated with mono- lineage, bi-lineage, and tri-lineage eytopenias, respectively accounted for 30. 1% （113/376）, 35.9% （135/376）, and 34. 0% （128/376）. Significant statistical differences （P〈0. 05） in post-operative prognostic could be noted in patients in contrast of mono-lineage cytopenias and multi-linage cytopeni- as. In all patients, postoperative prognosis demonstrated significant correlation with thrombocytope- nia, leukopenia and erythropenia （P〈0. 05）. According to the severity of thrombocytopenia, cytope- nia was graded as mild, medium and severe, referring to 〈2 grade,2-3 grade and 〉3 grade respec- tively. The prognosis revealed significant differences among three groups （P〈0. 05）. Conclusions Peripheral cytopenias can influence postoperative prognosis in patients with splenomegaly caused by post-hepatitic cirrhotic portal hypertension. The prognosis in patients associated with mono-linage pe- ripheral cytopenias is better than those associated with multi-linage cytopenias, and prognosis in pa- tients associated with mild peripheral cytopenias is obviously better than those associated with severe cytopenias. Our study demonstrates the more severe the peripheral cytopenias is, the worse the prog-nosis is.