脾切除并门奇静脉断流术术前行选择性脾动脉栓塞的临床应用价值.pdf

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1、中国现代医学杂志V()I．24No．2第24卷第2期2014年1月ChinaJournalofModernMedicineJan．2014文章编号：10{)5—8982(2014)02—0074一【)4脾切除并门奇静脉断流术术前行选择性脾动脉栓塞的临床应用价值朱盛兴，张俊杰，张应选(河北省郑州人民医院普三科，河南郑州450053)摘要：目的探讨肝硬化门静脉高压症脾切除并门奇静脉断流术术前选择性脾动脉栓塞的临床应用价值c方法选择肝硬化并上消化道出血患者158例，随机分为脾栓塞组(n=77)与非脾栓塞组(n一81o脾栓塞组行选择性脾动脉栓基(PSE)，栓塞

2、面积65％～75％，1周后行脾切除并门奇静脉断流术；非脾栓基组直接行脾切除并门奇静脉断流术。结果两组入选患者入组资料无差异(P>005o脾栓塞组脾栓1周后血小板恢复正常，白细胞、血红蛋白上升，凝血酶原时间缩短，睥切除并门奇静咏断流术术前临床检验指标明显优于非睥栓塞组(P<()．01，P<0．05)：手术出血量、输血量、血小板输注量、并发症发生率等指标明显优于非脾栓塞组(P()．05o结论脾切除并门奇静脉断流术术前先行脾动脉栓塞，可以使脾功能亢进得以恢复，增强了患者的手术耐受性，降低了手

3、术风险，减少了并发症发生率。关键词：肝硬化；脾功能亢进；选择性睥栓塞术；脾切除；门奇静脉断流术中图分类号：R575．2文献标识码：BClinicalpracticevalueofpartialsplenicembolizationbeforethecombinedsplenectomyandportalazygousdisconnectionfortreatmentofportalhypertensionZHUSheng-xing，ZHANGJun-jie，ZHANGYing—xuan(Departrnent0，’GenerolSurgery，Peop

4、leHospital，Zhengzhou，Henan450053，P．R．China)Abstract：【Objective】Toevaluatethesignificanceandclinicalpracticevalueofselectivepartialsplenicembolizationbeforethesplenectomyandportalazygousdisconnectionfortreatmentofportalhypertension．【Methods】Theuppergastrointestinalbleedingpatient

5、sn=158)suferedfromcirrhosisandportalhyperten—sionwererandomlydividedintotwogroups．Theselectivepartialsplenicembolizationgroup(n=77，groupA)whichwasDerformedwithselectivepartialsplenicembolizationandtheembolizationextentto65～75％andthenwastakensplenectomywithperiesophag0gastricdeva

6、scularizationafteraweek．Thenon—partialsplenicembolizationgroupn=81，groupB)waspefm'medWithsplenectomywithperies。phag0gastricdevascularizationdirectlv．SAS8．0sofwarewasusedforstatisticalanalysis．【Resets】PherewerenosignificantdifferencesinclinicalmaterialsofgroupAandgroupB伊>O．o5)．Th

7、eclinicallaboratorydataofgroupAisbetterthangroupBaweeklater(P<0．0l，P<0．05)，whoseplateletcanreturutonormal，thenumberofwhitebloodcellaridhemoglobincanincreaseandtheprothrombintimeisshortened．TheotherclinicallaboratorydataofgroupAisbetterthangroupBtot}．whichincludebloodlossduringop

8、eration，blcodtransfusion，complica—tionsandSOonf