脾肾分流术与断流术治疗门静脉高压症疗效的对比研究

A comparative study on splenorenal shunt and esophagogastric devascularization in the treatment of portal hypertension

目的比较脾肾分流术和传统断流术治疗门静脉高压症的临床疗效。方法回顾性分析2012年1月至2021年11月于南通大学附属医院行脾肾分流术和传统断流术109例乙肝肝硬化门静脉高压症患者的临床资料。结果分流组手术时间长于断流组,差异有统计学意义[(208±43)min比(172±53)min,t=-3.677,P<0.05];分流组与断流组术中出血量和术后住院时间相比差异均无统计学意义[(131±89)ml比(164±109)ml,t=1.621,P>0.05;(21±6)d比(21±8)d,t=-0.403,P>0.05]。术后两组中重度腹水、腹腔出血和肝性脑病发生率差异均无统计学意义(χ^(2)=0.973、0.830、0.095,均P>0.05)。分流组术后再出血率低于断流组,差异有统计学意义(5%比28%,χ^(2)=5.280,P<0.05)。手术方式是再出血的独立预测因素。分流组1、2、3、5年的累积生存率分别为95%、94%、91%、88%,断流组分别为95%、88%、85%、73%。再出血是影响生存率的独立危险因素。结论脾肾分流术比传统断流术在降低门静脉高压症患者术后再出血率和提高生存率方面有明显的优势。

Objective To compare the clinical efficacy of splenorenal shunt and traditional devascularization in the treatment of portal hypertension.Method The clinical data of 109 patients with portal hypertension due to hepatitis B cirrhosis undergoing splenorenal shunt and traditional devascularization at Affiliated Hospital of Nantong University from Jan 2012 to Nov 2021 were retrospectively analyzed.Results The operation time(208±43)min in shunt group was longer than that of(172±53)min in devascularization group(t=-3.677,P<0.05).The intraoperative blood loss of(131±89)ml and postoperative hospital stay(21±6)d in shunt group were not significantly different from those of(164±109)ml and(21±8)d in devascularization group(t=1.621,P>0.05;t=-0.403,P>0.05).There was no significant difference in the incidence of moderate to severe ascites,intraabdominal hemorrhage and hepatic encephalopathy between the two groups(χ^(2)=0.973,0.830,0.095,all P>0.05).The rebleeding rate in shunt group(5%)was lower than that in devascularization group(28%)(χ^(2)=5.280,P<0.05).The operation method was an independent predictor of rebleeding.The 1-,2-,3-,and 5-year cumulative survival rates in the shunt group were 95%,94%,91%and 88%,and in devascularization group were 95%,88%,85%and 73%.Rebleeding was an independent risk factor affecting the survival rate,and the risk of death in patients with postoperative rebleeding.Conclusion Compared with devascularization,splenorenal shunt has obvious advantages in reducing postoperative rebleeding rate and prolonging survival time.