探讨CT门静脉成像（CTPV）分型个体化手术治疗在肝硬化门静脉高压症中的应用价值。

本前瞻性研究对象为2010年6月至2014年12月在安徽医科大学附属省立医院行手术治疗的156例肝硬化门静脉高压症患者。根据手术方式的不同分为CTPV分型个体化手术组（分型组）和传统手术组（传统组）。其中分型组84例，男56例，女28例；年龄19～67岁，中位年龄45岁。传统组72例，男47例，女25例；年龄23～62岁，中位年龄43岁。所有患者均签署知情同意书，符合医学伦理学规定。分型组患者根据术前CTPV分型采取个体化手术方式，传统组行脾切除术+贲门周围血管离断术。观察两种手术方式对患者门静脉高压症、术中和术后情况以及术后生存率的影响。两组观察指标比较采用t 检验，生存分析采用Kaplan-Meier法和Log-rank检验。

分型组患者术后自由门静脉压（FPP）为（27±3）cmH₂O（1 cmH₂O=0.098 kPa），明显低于传统组的（33±8）cmH₂O（t=-3.355，P<0.05）；手术前后FPP下降幅度为（13±6）cmH₂O，明显大于传统组的（9±5）cmH₂O（t=3.016，P<0.05）。分型组的手术时间、术中出血量为（188±84）min、（378±49）ml，明显少于传统组的（240±76）min、（463±57）ml（t=-2.687，-3.015；P<0.05）。分型组的术后住院时间、住院费用为（12±4）d、（3.1±1.5）万元，明显低于传统组的（15±5）d、（3.6±1.5）万元（t=-2.061，-2.104；P<0.05）。分型组的1、3年累积生存率分别为94.05%、85.71%，传统组分别为87.50%、68.05%，分型组的总体生存率明显高于传统组（χ²=7.000，P<0.05）。

对肝硬化门静脉高压症患者进行术前CTPV分型并采取个体化手术治疗，能有效降低门静脉压力，且具有创伤较小、预后较好等优点。

To explore the application value of individualized surgical treatment based on the CT portal venograpy (CTPV) classification in cirrhotic portal hypertension.

One hundred and fifty-six patients with cirrhotic portal hypertension who received surgical treatment in Anhui Province Hospital between June 2010 and December 2014 were enrolled in this prospective study. According to different surgical procedures, the patients were divided into two groups: the individualized surgery based on CTPV classification group (classification group) and traditional surgery group (traditional group). Among the 84 patients in the classification group, 56 were males and 28 were females with the age ranging from 19 to 67 years old and the median of 45 years old. Among the 72 patients in the traditional group, 47 were males and 25 were females with the age ranging from 23 to 62 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients in the classification group underwent individualized surgery according to the pre-operative CTPV classification, while the patients in the traditional group underwent splenectomy + pericardial devascularization. The effects of two surgical procedures on the portal hypertension, intraoperative and postoperative conditions and postoperative survival rate of the patients were observed. The observation indexes of two groups were compared using t test and survival analysis was conducted using Kaplan-Meier method and Log-rank test.

The postoperative free portal pressure (FPP) in the classification group was (27±3) cmH₂O (1 cmH₂O=0.098 kPa), significantly lower than (33±8) cmH₂O in the traditional group (t=-3.355, P<0.05). The FPP decrease range before and after surgery in the classification group was (13±6) cmH₂O, significantly higher than (9±5) cmH₂O in the traditional group (t=3.016, P<0.05). The length of surgery and intraoperative blood loss in the classification group were respectively (188±84) min and (378±49) ml, significantly less than (240±76) min and (463±57) ml in the traditional group (t=-2.687, -3.015; P<0.05). The postoperative length of stay and hospitalization expense in the classification group were respectively (12±4) d and (31 000 ± 15 000) yuan, significantly lower than (15±5) d and (36 000±15 000) yuan in the traditional group (t=-2.061, -2.104; P<0.05). The 1, 3-year accumulative survival rate were respectively 94.05% and 85.71% in the classification group, and were respectively 87.50% and 68.05% in the traditional group. The overall survival rate in the classification group was significantly higher than that in the traditional group (χ²=7.000, P<0.05).

Pre-operative CTPV classification and individualized surgical treatment for patients with cirrhotic portal hypertension can effectively reduce the portal vein pressure and has the advantages of smaller injury and better prognosis.