脾切除联合门奇静脉断流术对肝硬化合并门静脉高压症患者近远期营养状况的影响

The impact of splenectomy and esophagogastric devascularization on the nutrition status of patients with cirrhosis and portal hypertension

目的探讨脾切除联合门奇静脉断流术对肝硬化合并门静脉高压症患者营养状况的影响。方法2015年4月5日至2017年1月23日连续就诊首都医科大学附属北京佑安医院普通外科的肝硬化合并门静脉高压症患者共计60例。前瞻性检测术前、术后1周，术后1、3、6个月及术后1年的体质量指数（BMI）、白蛋白（Alb）、前白蛋白（PA）、淋巴细胞总数，将各检测指标的术后各时间点检测值与同组配对患者的术前水平进行对比分析。结果术后1周、术后1个月BMI较同组配对患者的术前水平明显降低[（22．14±3．08）kg／nl。比（22．85±3．14）kg／m^2，（21．72±3．05）kg／m^2比（22．86±3．16）kg／m^2]，差异有统计学意义（P〈0．05）；术后1年BMI较同组配对患者的术前水平明显升高[（23．24±3．64）kg／m^2比（22．68±3．47）kg／m^2]，差异有统计学意义（P〈0．05）。术后1、3个月Alb较同组配对患者的术前水平明显升高[（39．87±4．22）g／L比（35．35±5．15）g／L、（39．35±4．75）g／L比（34．82±5．50）g／L]，差异有统计学意义（均P〈0．05）。术后1周PA较同组配对患者的术前水平明显降低[（79．59±26．52）mg／L比（121．77±39．96）mg／L]，差异有统计学意义（P〈0．05）。各时间点淋巴细胞总数均较术前明显升高（均P〈0．05）。结论脾切除联合门奇静脉断流术能改善肝硬化合并门静脉高压症患者近、远期的营养状况。

Objective To study the impact of splenectomy and esophagogastric devascularization on the nutritional status of patients with cirrhosis and portal hypertension. Methods Sixty consecutive patients with cirrhosis and portal hypertension who underwent splenectomy and esophagogastric devascularization at the Beijing YouAn Hospital from April 5, 2015 to January 23, 2017 were included in this study. The body mass index （BMI）, albumin （Alb）, prealbumin （PA） and lymphocyte counts were prospectively collected at the end of 1-week, 1-month, 3-month, 6-month and 1-year after surgery. The postoperative results were compared with the preoperative results in these patients. Results The BMI results obtained at 1-week and 1-month after surgery were significantly lower than the preoperative level [ （22. 14 ± 3.08 ）kg/m2 vs. （22. 85 ± 3.14） kg/m2, （21.72 ± 3.05） kg/m2 vs. （22. 86 ± 3.16） kg/m2, P 〈 0. 05 ]. The BMI result at the end of 1-year after surgery was significantly elevated when compared with the preoperative level [ （23.24 ± 3.64） kg/m2 vs. （ 22. 68 ± 3.47 ） kg/m2, P 〈 0. 05 ]. The ALB levels at 1-month and 3-month after surgery were significantly higher than the preoperative level [ （39.87 ± 4. 22 ）g/L vs. （35.35 ± 5. 15 ） g/L, （39.35 ± 4. 75 ） g/L vs. （34. 82 ± 5.50） g/L, P 〈 0. 05 ]. The PA obtained at 1-week alter sur- gery was significantly lower than the preoperative levels [ （79.59 ± 26. 52 ）mg/L vs. （121.77 ± 39. 96）mg/L, P 〈 0. 05 ]. The lymphocyte counts at all the points after surges were significantly higher than the preoperative level （P 〈 0. 05）. Conclusion Short term and long term nutritional status improved in patients with cirrhosis and portal hypertension after splenectomy and esophagogastric devascularization.