逆行脾切除术——治疗门脉高压症并切除巨脾的好方法

Retrograde Splenectomy ——A Good Operative Procedure in the Treatment of Portal Hypertension

目的 :评价肝硬变、门脉高压症并巨脾和脾功能亢进病人行逆行脾切除术、门奇静脉断流术的优越性。方法 :比较分析逆行脾切除术 (逆切组 ,38例 )与经典脾切除术 (经切组 ,5 1例 )加门奇静脉断流治疗肝硬变、门脉高压症、巨脾、脾功能亢进合并食管胃底曲张静脉出血的临床经验。结果 :逆切组无术中大出血 (平均失血量 2 92mL) ,无手术死亡 ;经切组2 1例大出血 (>10 0 0mL) ,最多达 2 0 0 0mL ,平均失血量 935mL ,手术死亡 3例 ,两组比较有统计学意义 (P <0 0 1)。术后随访 3个月～3年 78例 ,均未见食管胃底曲张静脉复发出血。结论 :逆行脾切除术加门奇静脉断流较经典脾切除术出血少 ,死亡率低 。

Objective:To evaluate the effect of splenectomy plus divascularization in the treatment of portal hypertension, giant splenomegaly and hypersplenism caused by liver cirrhosis.Methods:The retrograde splenectomy plus divascularization and classical splenectomy plus divascularization were used to treat the portal hypertension,giant splenomegaly,hypersplenism with esophageal and gastric varices bleeding caused by liver cirrhosis.Results:There was no one died in retrograde splenectomy group,without massive bleeding during operation(the average amount bleeding of 292 mL).But in classical splenectomy group,there were 3 died in 21,in whom the amount of massive bleeding was more than 1 000 mL, with the highest one 2 000mL, and the average of 935mL.There was significant difference in two groups(P<0.01).After operation 78 patients were followed up from 3 months to 3 years,without recurrent esophageal and gastric varices hemorrhage.Conclusion:Compared with the classical splenectomy plus divascularization,the retrograde splenectomy plus divascularization is a good operative procedure, with less bleeding and lower mortality.