比较改良脾-肺固定术与断流术治疗肝硬化门静脉高压症的临床疗效。

回顾性分析2011年1月至2015年12月在郑州大学第一附属医院行手术治疗的60例肝硬化门静脉高压症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。根据手术方式将患者分为改良脾-肺固定组和脾切除+断流术组（断流组）。其中改良脾-肺固定组26例，男18例，女8例，平均年龄（41±9）岁；断流组34例，男22例，女12例；年龄（44±8）岁。两组患者术后血细胞、门静脉压力比较采用t检验，并发症发生率比较采用χ²检验。

改良脾-肺固定组术后1年自由门静脉压力为（32.6±1.8）cmH₂O（1 cmH₂O=0.098 kPa），明显高于断流组的（29.9±2.3）cmH₂O（t=4.963，P<0.05）；WBC、Hb、Plt分别为（4.1±1.5）×10⁹/L、（101±18）g/L、（102±40）×10⁹/L，明显低于断流组的（5.8±1.9）×10⁹/L、（113±16）g/L、（220±70）×10⁹/L（t=-3.798，-2.588，-8.218；P<0.05）；门静脉血栓形成率为8%（2/26），明显低于断流组的29%（10/34） （χ²=4.344，P<0.05）。改良脾-肺固定组和断流组的上消化道出血率、肝性脑病发生率分别为15%（4/26）、4%（1/26）和9%（3/34）、9%（3/34），差异无统计学意义（χ²=0.143，0.059；P>0.05）。

与断流术相比，改良脾-肺固定术防治上消化道出血和肝性脑病疗效相似，且具有术后门静脉血栓发生率较低、保留部分脾脏功能和较高的门静脉压力利于肝脏灌注的优势。

To compare the clinical efficacy between modified splenopneumopexy and devascularization for cirrhotic portal hypertension.

Clinical data of 60 patients with cirrhotic portal hypertension who underwent surgery in the First Affiliated Hospital of Zhengzhou University between January 2011 and December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the surgery procedures, the patients were divided into the modified splenopneumopexy group (n=26) and splenectomy combined with devascularization group (devascularization group, n=34). In the modified splenopneumopexy group, 18 cases were males and 8 were females, aged (41±9) years old on average. In the devascularization group, 22 cases were males and 12 were females, aged (44±8) years on average. Postoperative blood cells and portal venous pressure of two groups were compared using t test. The incidence of complications was compared using Chi-square test.

The free portal venous pressure at postoperative 1 year in the modified splenopneumopexy group was (32.6±1.8) cmH₂O (1 cmH₂O=0.098 kPa), significantly higher than (29.9±2.3) cmH₂O in the devascularization group (t=4.963, P<0.05). The level of WBC, Hb and Plt in the modified splenopneumopexy group was respectively (4.1±1.5)×10⁹/L, (101±18) g/L and (102±40)×10⁹/L, significantly lower than (5.8±1.9)×10⁹/L, (113±16) g/L and (220±70)×10⁹/L in the devascularization group (t=-3.798, -2.588, -8.218; P<0.05). The incidence of portal thrombosis in the modified splenopneumopexy group was 8%(2/26), significantly lower than 29%(10/34) in the devascularization group (χ²=4.344, P<0.05). The incidence of upper gastrointestinal hemorrhage and hepatic encephalopathy in the modified splenopneumopexy group and devascularization group was respectively 15%(4/26), 4%(1/26) and 9%(3/34), 9%(3/34), and no significant differences were observed (χ²=0.143, 0.059; P>0.05).

Compared with the devascularization technique, modified splenopneumopexy has similar clinical efficacy in the prevention and treatment of upper gastrointestinal hemorrhage and hepatic encephalopathy, and has the advantages of lower incidence of postoperative portal venous thrombosis, preserving partial spleen function and higher portal venous pressure which is beneficial to liver perfusion.