Effect of splenectomy plus pericardial devascularization on coagulation function in patients with cirrhotic portal hypertension
-
摘要: 目的分析脾切除贲门周围血管联合手术后,肝硬化门静脉高压症患者血小板数量、平均体积和血流动力学的改变,探讨其对凝血功能的影响。方法选取中国人民解放军第四军医大学第二附属医院2008年1月至2012年12月经脾切除贲门周围血管联合手术治疗的肝硬化门静脉高压症患者83例进行回顾性分析。计量资料组间比较采用配对t检验。结果手术后门静脉压力较术前下降,血流量变小,门静脉内径显著变窄;术后肝动脉内径变宽,肝动脉血流量增加。术后30 d ALT、白蛋白(Alb)、总蛋白(TP)、纤维蛋白原(FIB)、凝血酶时间(TT)以及血小板平均体积(MPV)值较术前7 d无明显变化(P>0.05),而TBil、部分活化凝血酶(APTT)和凝血酶原时间(PT)3项指标有所下降(P<0.05);血小板(PLT)及凝血酶原时间活动度(PTA)上升(P<0.05),术后30 d与术前7 d相比较,患者PLT数量显著增加(P<0.05),但MPV无显著改变(P>0.05)。结论脾切除贲门周围血管联合手术能够明显改善肝硬化门静脉高压症患者肝脏功能储备及凝血功能。Abstract: Objective To determine platelet count (PLT) , mean platelet volume (MPV) , and hemodynamic changes in patients with cirrhotic portal hypertension (CPH) post splenectomy plus pericardial devascularization (SPPD) , and to assess the surgical effect on coagulation function. Methods A retrospective analysis was performed on 83 CPH patients undergoing SPPD in our hospital from January 2008 to December 2012. Results Compared with preoperative levels, postoperative portal venous pressure decreased, blood flow was reduced, and portal vein diameter was significantly reduced; additionally, postoperative hepatic artery diameter was increased, and hepatic artery blood flow increased. Blood alanine aminotransferase, albumin, total protein, and fibrinogen levels, thrombin time, and MPV did not significantly change 30 days postoperatively versus 7 days preoperatively (P > 0. 05) ; the corresponding total bilirubin, activated partial thromboplastin time and prothrombin time relatively declined (P < 0. 05) , whereas PLT and prothrombin time activity increased (P < 0. 05) . There was a significant increase in PLT (P < 0. 05) but no significant change in MPV 30 days postoperatively versus 7 days preoperatively (P > 0. 05) .Conclusion SPPD can significantly improve liver functional reserve and coagulation function in patients with CPH.
-
Key words:
- liver cirrhosis /
- splenectomy /
- hypertension, portal /
- platelet count /
- hemodynamics
-
[1]JIN S, DAI CL.Splenectomy in patients with liver cirrhosis and portal hypertension[J].World Chin J Dig, 2010, 18 (33) :3533-3538. (in Chinese) 金山, 戴朝六.肝硬化门脉高压症脾切除术[J].世界华人消化杂志, 2010, 18 (33) :3533-3538. [2]NI JL, LIU XM, CHEN Z, et al.Effects of double devascularization procedure on hemodynamics and recent and long-term hepatic function of portal hypertensive patients[J].Clin J Curr Adv Gen Surg, 2010, 13 (3) :209-212. (in Chinese) 倪家连, 刘晓明, 陈中, 等.贲门周围壁内外双重断流术治疗门脉高压症对肝脏血流及近远期功能的影响[J].中国现代普通外科进展, 2010, 13 (3) :209-212. [3]NAGASUE N, DHAR DK, YAMANOI A, et al.Production and release of endothelin-1 from the gut and spleen in portal hypertension dueto cirrhosis[J].Hepatology, 2000, 31 (4) :1107-1114. [4]XIONG BX, LIU DR, LI HL, et al.Effects of various surgical procedures on portal hemodynamice in patients with portal hypertension[J].Acta Acad Med Jiangxi, 2007, 47 (1) :11-13. (in Chinese) 熊炳贤, 刘大仁, 李红浪, 等.门静脉高压症不同术式对门静脉系统血流动力学的影响[J].江西医学院学报, 2007, 47 (1) :11-13. [5]ZHAO XF, LYU HL, ZHANG SJ, et al.Devascularization of liver with portal hypertension hemodynamics and liver reserve function[J].J Nongken Med, 2011, 33 (1) :38-41. (in Chinese) 赵雪峰, 吕海龙, 张示杰, 等.断流术对门静脉高压症肝脏血液动力学及肝储备功能的影响[J].农垦医学, 2011, 33 (1) :38-41. [6]LIU MT, FENG YQ, LIU HF.Clinical significance of the change of platelet function in patients with liver cirrhosis[J].Clin Med, 2002, 22 (2) :14. (in Chinese) 刘明涛, 冯业全, 刘海峰.肝硬化患者血小板功能变化的临床意义[J].临床医学, 2002, 22 (2) :14. [7]DING XJ, SHEN D, LIN BJ, et al.Practicl haematology[M].Shanghai Medical University Press, 1992:221-223. (in Chinese) 丁训杰, 沈迪, 林宝爵, 等.实用血液病学[M].上海医科大学出版社, 1992:221-223. [8]YU LX, LI ZW, GUO XD, et al.The effect of liver function in patients with cirrhosis and portal hypertension after splenectomy and pericardial blood vessels disarticulation[J].Prog Mod Biomed, 2013, 13 (5) :950-953. (in Chinese) 余灵祥, 李志伟, 郭晓东, 等.脾切断流术对肝硬化门静脉高压症患者肝功能的影响[J].现代生物医学进展, 2013, 13 (5) :950-953. [9]OROZCO H, MERCADO MA.The evolution of portal hypertension surgery:lessons from 1000 operations and 50 Years'experience[J].Arch Surg, 2000, 135 (12) :1389-1393, 1394.
本文二维码
计量
- 文章访问数: 2437
- HTML全文浏览量: 20
- PDF下载量: 495
- 被引次数: 0