摘要
目的探讨贲门周围血管离断术(PCDV)联合脾切除术治疗门静脉高压症(PHT)的临床疗效及其对围术期指标、血清肝细胞生长因子(HGF)、转化生长因子-β_(1)(TGF-β_(1))的影响。方法回顾性分析91例PHT患者的临床资料,按照不同的治疗方式分为观察组53例(接受选择性PCDV联合脾切除术治疗)和对照组38例(接受传统PCDV联合脾切除术治疗)。比较2组临床疗效、手术情况及并发生发生率;比较2组手术前后总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、血清白蛋白水平(ALB)、凝血酶原时间(PT)、血清HGF及TGF-β_(1)水平。结果观察组食管胃底静脉曲张(EGV)改善情况优于对照组,肝功能Child-Pugh评分低于对照组,自由门静脉压(FPP)差值高于对照组,差异均有统计学意义(P<0.05);观察组手术时间、术中出血量、术后通气时间、引流时间、住院时间均少于、短于对照组,差异有统计学意义(P<0.05)。2组患者术后TBIL、ALT、PT均低于术前,ALB均高于术前,差异有统计学意义(P<0.05);观察组术后血清HGF水平高于对照组,TGF-β_(1)水平低于对照组,差异有统计学意义(P<0.05)。术后3个月内,2组均未发生胰瘘、脾脓肿、肝性脑病,观察组发热及消化道再出血发生率低于对照组,差异有统计学意义(P<0.05)。结论选择性PCDV联合脾切除术治疗PHT的临床疗效优于传统非选择性PCDV联合脾切除术,可增强肝细胞再生能力,改善肝功能障碍,降低术后发热、消化道再出血等并发症的发生率。
Objective To explore the clinical efficacy of pericardial devascularization(PCDV) combined with splenectomy in the treatment of patients with portal hypertension(PHT) and its influence on perioperative indicators,serum hepatocyte growth factor(HGF) and transforming growth factor-β_(1)(TGF-β_(1)). Methods Clinical materials of 91 patients were analyzed retrospectively,and the patients were divided into observation group(53 cases,treated with selective PCDV and splenectomy) and control group(38 cases,treated with traditional PCDV and splenectomy) according to different therapeutic methods. The clinical efficacy,surgical condition and incidence of complications were compared between the two groups;the total bilirubin(TBIL),alanine aminotransferase(ALT),serum albumin(ALB) level,prothrombin time(PT),serum HGF and TGF-β_(1)before and after operation were compared between the two groups. Results Improvement of esophagogastric varices(EGV) in the observation group was significantly better than that in the control group,the Child-Pugh score of liver function was significantly lower than that in the control group,and the difference value of free portal pressure(FPP) was significantly higher than that in the control group(P<0.05);the operation time,intraoperative blood loss,postoperative exhaust time,drainage time and hospital stay in the observation group were significantly less or shorter than those in the control group( P <0. 05). The TBIL,ALT and PT after surgery were significantly lower than those before surgery in both groups,while the ALB was higher than that before surgery( P < 0. 05);the level of serum HGF after in the observation group was significantly higher than that in the control group,while the TGF-β1was significantly lower than that in the control group( P < 0. 05). Within 3 months after operation,no pancreatic fistula,splenic abscess and hepatic encephalopathy occurred in both groups,and the incidence rates of fever and gastrointestinal rebleeding in the observation group were significantly lower than those in the control group( P < 0. 05). Conclusion Selective PCDV combined with splenectomy is better than traditional non-selective PCDV combined with splenectomy in the treatment of PHT,which can enhance the ability of hepatocyte regeneration,improve liver dysfunction,and reduce the incidence of complications such as postoperative fever and gastrointestinal rebleeding.
作者
邓杰文
石帅
唐卫东
杨秀林
姜超
许承
DENG Jiewen;SHI Shuai;TANG Weidong;YANG Xiulin;JIANG Chao;XU Cheng(Department of General Surgery,Sichuan Science City Hospital,Mianyang,Sichuan,621000;Department of Radiology,Sichuan Science City Hospital,Mianyang,Sichuan,621000)
出处
《实用临床医药杂志》
CAS
2022年第12期107-111,共5页
Journal of Clinical Medicine in Practice
基金
2020年绵阳市卫健委立项科研项目(202002)。
