部分脾栓塞术对后期脾切除术联合食管胃底静脉断流术的影响

Effect of Partial Splenic Embolization on Splenectomy plus Devascularization of Esophageal and Gastric Vein

目的 探讨部分脾栓塞术对脾切除术联合食管胃底静脉断流术的影响。方法 回顾性分析笔者所在医院2010年6月至2015年6月期间收治的23例接受部分脾栓塞术后再行脾切除术联合食管胃底静脉断流术的肝硬变门静脉高压合并脾功能亢进患者，以及同期接受脾切除术联合食管胃底静脉断流术的30例肝硬变门静脉高压合并脾功能亢进患者的临床资料，比较2组患者的手术时间、术中出血量、术中输血量、术后腹腔引流管总引流量、术后胃肠功能恢复时间、住院时间及并发症发生率。结果 部分脾栓塞组的手术时间[（3.56±0.70） h比（1.78±0.28） h]、术中出血量（900 mL比250 mL）、术中输血量（800 mL比200 mL）、术后腹腔引流管总引流量（450 mL比150 mL）、术后胃肠功能恢复时间[（43.38±18.68） h比（27.60±12.39） h]、住院时间（12 d比7 d）及切口感染发生率[34.8%（8/23）比10.0%（3/30）]均长于或高于非部分脾栓塞组（P＜0.05）。2组患者术后均获访，随访时间为6～58个月，中位数为28个月。随访期间2组均无再发消化道大出血病例。结论 肝硬变门静脉高压合并脾功能亢进患者接受部分脾栓塞术后再行脾切除术的手术难度大、术中出血多、术后并发症多及术后恢复慢，应当根据患者的具体病情选择部分脾栓塞术或直接外科脾切除术，以实施个体化治疗，才能使患者最大获益。

Objective To explore the effect of partial splenic embolization on splenectomy plus devascularization of esophageal and gastric vein. Methods Twenty three cirrhosis patients with portal hypertension combined the hypersplenism （partial splenic embolization group）, who received partial splenic embolization in our hospital from June 2010 to June 2015, as well as 30 cirrhosis patients with portal hypertension combined the hypersplenism without undergoing partial splenic embolization in the same period （non-partial splenic embolization group）, were collected retrospectively. All patients underwent splenectomy plus devascularization of esophageal and gastric vein. Comparison of operation time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative total flow of abdominal drainage tube, postoperative gastrointestinal function recovery time, hospital stay, and the incidence of complication was performed. Results The operation time[（3.56±0.70） h vs. （1.78±0.28） h], intraoperative blood loss （900 mL vs. 250 mL）, intraoperative blood transfusion volume （800 mL vs. 200 mL）, postoperative total flow of abdominal drainage tube （450 mL vs. 150 mL）, postoperative gastrointestinal function recovery time[（43.38±18.68） h vs. （27.60±12.39） h], hospital stay （12 d vs. 7 d）, and incidence of incision infection[34.8% （8/23） vs. 10.0% （3/30）] of partial splenic embolization group were all higher or longer than those corresponding indexes of non-partial splenic embolization group （P〈0.05）. All patients of 2 groups were followed up by telephone visit for 6-58 months, and the median was 28-month. There was no recurrence of gastrointestinal hemorrhage during the follow-up period. Conclusions Splenectomy is more difficult, and maybe has more intraoperative blood loss and complications for cirrhosis patients with portal hypertension combined the hypersplenism, who received partial splenic embolization ever. For these patents, the recovery time is longer. We should make choice of partial splenic embolization or splenectomy directly according to the patients＇ situation, to implement individualized treatment, so we can make the biggest benefit for patients.