脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者肝功能及血流动力学的影响

Effect of splenectomy combined with pericardial vascular dissection on liver function and hemodynamics in patients with cirrhosis of the portal vein

目的探讨脾切除+贲门周围血管离断术对肝硬化门静脉高压症(PHT)患者肝功能、血流量及门静脉压力影响。方法选择2012年6月至2017年6月间河池市人民医院接受治疗的PHT患者96例,依据随机数字表法将患者分为两组,观察组(48例)采用手术治疗,对照组(48例)采用保守治疗。检测观察组患者手术前肝动脉与门静脉的流量、内径、均速、谷速和峰速情况,同时检测治疗前后两组患者凝血酶原时间(PT)、总胆红素(TBIL)、白蛋白(ALB)及丙氨酸氨基转移酶(ALT)水平改变情况。结果 (1)对照组患者治疗前TBIL、ALT质量浓度分别为(54.28±23.04)mmol/L、(88.05±33.72)U/L,治疗后显著降低至(41.63±20.11)mmol/L、(67.92±35.73)U/L,差异有统计学意义(t=2.866、2.839,P=0.043、0.036),观察组治疗前PT、TBIL、ALB及ALT质量浓度分别为(19.83±2.80)s、(52.64±20.51)mmol/L、(25.06±4.15)g/L、(86.40±35.16)U/L,治疗后显著下降至(15.96±2.74)s、(28.78±11.30)mmol/L、(30.03±2.53)g/L、(41.37±24.39)U/L,差异有统计学意义(t=6.844、7.059、7.084、7.291,P=0.013、0.024、0.008、0.005)。(2)与术前比较,观察组患者术后门静脉流量及内径均显著降低(t=9.289、10.883,P=0.005、0.026),肝动脉流量、内径、均速、峰速和谷速显著上升(t=9.180、22.045、10.281、21.044、9.277,P=0.014、0.028、0.028、0.019、0.023),差异均有统计学意义。(3)观察组患者开腹后自由门静脉压为(29.09±1.37)mm Hg,结扎脾动脉、脾脏切除后压力显著降低至(22.68±1.18)、(20.29±1.09)mm H(g t=24.561、10.308,P=0.035、0.042);断流后压力则显著升高至(23.39±1.20)mm Hg,差异均有统计学意义(t=13.248,P=0.036)。结论脾切除联合贲门周围血管离断术可改善PHT患者肝功能,降低门静脉压力和血流量,增加肝动脉的血流量。

Objective To study the effect on liver function, portal vein pressure and blood flow for portal hypertension（PHT） patients after splenectomy＋pericardial devascularization. Methods From June 2012 to June 2017, ninety-six patients underwent PHT in Hechi People＇s Hospital, and were divided into two groups according to random number table method, the observation group（48 cases） treated by surgery, the control group（48 cases） received conservative treatment. Patients in the observation group were detected before surgery of hepatic artery and portal vein flow, diameter, average rate Valley, velocity and peak velocity, while detected prothrombin time（PT）, total bilirubin（TBIL）, albumin（ALB） and alanine aminotransferase（ALT） level change before and after treatment. Results（1） Before treatment, the concentration of TBIL and ALT in the control group was（54.28±23.04） mmol/L and（88.05±33.72） U/L respectively, which decreased to（41.63±20.11） mmol/L,（67.92±35.73） U/L after treatment（t=2.866, 2.839, P=0.043, 0.036）. PT, TBIL, ALB and ALT concentrations in the observation group before treatment were（19.83±2.80） s,（52.64±20.51）mmol/L,（25.06±4.15） g/L,（86.40±35.16） U/L, which decreased to（15.96±2.74） s,（28.78±11.30） mmol/L,（30.03±2.53）g/L,（41.37±24.39） U/L after treatment, respectively（t=6.844, 7.059, 7.084, 7.291, P=0.013, 0.024, 0.008, 0.005）.（2） Compared with preoperation, portal vein flow and diameter of the patients in the observation group were significantly decreased（t=9.289, 10.883, P=0.005, 0.026）, hepatic artery flow, diameter, velocity, peak velocity and velocity were increased significantly（t=9.180, 22.045, 10.281, 21.044, 9.277, P=0.014, 0.028, 0.028, 0.019, 0.023）. The differences were statistically significant.（3） Free portal pressure of patients in the observation group was（29.09±1.37） mm Hg after opening; pressure was significantly reduced to（22.68±1.18）,（20.29±1.09） mm Hg after splenic artery ligation and splenectomy, respectively（t=24.561, 10.308, P=0.035, 0.042）; while after the disconnection, the pressure increased significantly to（23.39±1.20） mm Hg（t=13.248, P=0.036）. Conclusion Splenectomy combined with pericardial vascular dissection can improve the liver function of PHT patients, reduce portal pressure and blood flow, and increase the blood flow of the hepatic artery.