改良Sugiura手术加自体脾移植治疗门静脉高压症的临床研究.doc

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1、改良Sugiu口手术加自体脾移植治疗门静脉髙压症的临床研究作者：张始业段升军吕徳泉王春祥单位：济南市第三人民医院普外科【摘要】目的：评价改良Sugiura手术加自体脾移植治疗门静脉高压症的效果。方法：应用改良Sugiura手术加自体脾移植治疗门静脉高压症患者45例（研究组），与同时期45例行贲门周围血管离断术的患者（对照组）进行对比研究。结果：研究组术后无死亡病例，近期止血效果确切，随访吋间0.5〜4年，肝性脑病发生率为4.4%（2/45）,再出血率为2.2%（1/45）；术后所有患者食管下段静脉

2、曲张消失或明显好转；术后再出血率及静脉消失率两纽.比较差异均有统计学意义（PV0.05）。研究组术后2个月血清Tuftsin和IgM水平下降不显著，术后随访移植脾块同位素显像呈阳性，I何对照纽•无阳性显像。结论：改Sugiuraf-术加部分自体脾移植手术操作较简单、再出血率低、并发症少且保留脾脏的免疫功能，是一•种值得推广的治疗门静脉高压症手术方法。【关键词】高血压，门静脉•改良Sugiura手术•移植，白体•脾C1inica1studyofmodifiedsugiu

3、raprocedureplussp1eenautotransplatationinthetreatmentofportalhypertensionZHANGShi-ye,DUANSheng-jun,LüDe-quan,WANGChun-xiang,SUNXiao-dongDepartmentofGeneralSurgery,ThirdPeoplesHospitalofJinan（Jinan250101,China）[ABSTRACT]Objective:Toevaluatetheeffe

4、ctofmodifiedSugiuraprocedureplusspleenautotransplantationintreatmentofportalhypertension.Methods:From2（X）3to2007,45patientswithportalhypertensionunderwentmodifiedSugiuraprocedureplusspleenautotransplantation,and45patinetsunderwentpericardialdevascular

5、ization.Results:Therewasnopostoperationalmortality.Theimmediateeffectonthehemorrhageandrecentresponseofthepatientsweresatisfactory.After0.5yearsto4yearsoffollowup,thehepaticencephalopathyincidencewas4.5%andrecurrentvaricealbleedingratiowas2.2%.Allpati

6、entsshowedthatesophagealvaricesdisappearedorremarkablyameliorated.Thereweresignificantdifferenceofrecurrentvaricealbleedingratebetweentwogroups.ThepreoperativelevelsofserumTuftsinandIGMshowednostatisticaldifferencebetweengroups.HoweverserumtuftfinandI

7、GMdecreasedremarkablyinthecontrolgroup.Theautotransplantationgroupshowedthetransplantedsplenicfragmentduringfollow-up.Conclusion:ModifiedSugiuraprocedureplusspleenautotransplantationisrelativelysimple.Therateofcomplication,rebleedingislow.Atthesametim

8、ethesplenicimmunefunctionwerepresreved.It’sadeservedpopularizedmethod.【KEYWORDS]Hypertension,portal•ModifiedSugiuraprocedure•Transplardaiion,autologous•Spleen典型的Sugiura手术创伤大，死亡率较高，国内外很少采用。改良的Sugiura手术临床应用较多，但有效止血、防ll.HlJfl