脾动脉部分栓塞后脾功能亢进复发采用脾切除术治疗的临床观察

Clinical observation of splenectomy for the treatment of the patients with hypersplenism recurrence after partial splenic embolization for hypersplenism

目的探究采用脾切除术治疗脾动脉部分栓塞后脾功能亢进复发的临床疗效。方法选取本院于2004年8月至2014年8月收治的脾动脉部分栓塞后脾功能亢进复发患者28例,全部患者采用脾切除术加贲门周围血管离断术的治疗方法 ,观察患者治疗后的临床疗效。结果所有患者手术均获得成功,术中见脾脏与周围结肠、胃、膈肌等组织有明显粘连,手术时间为(165.73±48.79)min,术中分离时出现胃损伤2例,膈肌损伤1例;患者术中出血量为(1100±200)ml,术后出血量为(840.25±209.86)n11;切除脾脏重量为(375.8l±108.37)g,术后出现反应性胸腔积液14例、胰瘘1例。与治疗前相比,患者的谷丙转氨酶、谷草转氨酶均有下降,但下降程度不明显(P>0.05),无统计学意义;术后1周患者血小板和白细胞计数与治疗前相比有很大程度提高(P<0.05),差异有统计学意义。结论脾切除术治疗脾动脉部分栓塞后脾功能亢进复发效果良好,术中需仔细分离,小心周围器官的副损伤;术后能够有效消除脾功能亢进症状,对肝功能损伤小,值得临床推广。

Objective To investigate the clinical curative effect of splenectomy for the treatment of the patients with hypersplenism recurrence after partial splenic arterial embolization.Methods Twenty eight patients with hypersplenism recurrence after partial splenic arterial embolization underwent splenectomy combined with periesophagogastric devascularization from August 2004 to August 2014. The clinical outcome was analyzed.Results All patients were successfully operated. Adhesion of spleen to peripheral organism of colon, stomach and diaphragm was seperated intraoperatively, with 2 stomach injury and 1 diaphragm injury. Operation time was(165.73±48.79)min; The intraoperative blood lose and postoperative blood lose was (1100±200)ml and (840.25+209.86) ml respectively. Spleen specimen weighed (375.81±108.37) g. There were 14 cases with reactive pleural effusion and 1 patient with pancreatic fistula after operation. The level of AST and ALT did not obviously decrease after operation without statistically significance (P>0.05).But the amount of platelet and white blood cell counts obviously increased 1 week after operation with statistically significance(P<0.05).Conclusion Splenectomy is an effective therapeutic measure for the treatment of the patients with hypersplenism recurrence after partial splenic arterial embolism. The patients with hypersplenism relieved after operation with less liver function damage. It should be recommended to apply. But carefulness should be taken to avoid the injury of the peripheral tissue during operation.