兰州大学机构库 >学院待认领
116例门脉高压症合并脾功能亢进施行脾切除术的安全性分析
Alternative TitleThe security analysis of portal hypertension with hypersplenism after splenectomy :116 cases report
郭臣
Thesis Advisor曹农
2015-05-22
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword门脉高压 脾功能亢进 安全性分析
Abstract目的 肝硬化作为门静脉高压常见的发病原因之一,其所导致的肝功能代偿引起门静脉高压是脾功能亢进的最常见原因。目前关于门静脉高压合并脾功能亢进的治疗途径主要是外科手术。本研究通过收集2013年1月-2014年12月在兰州大学第一医院住院的门静脉高压合并脾功能亢进施行脾切除术的患者为研究对象,探讨门静脉高压合并脾功能亢进施行脾切除同围术期安全性的关联以及脾切除对机体的影响。方法 收集2013年1月-2014年12月在兰州大学第一医院住院的门静脉高压合并脾功能亢进施行脾切除术116例患者,依据患者手术指征分别行单纯脾切除术、脾切除+断流术、脾切除+分流术以及脾切除+联合断流分流术,观察患者术前以及术后7天、1个月、3个月、6个月的恢复指标、并发症指标等。结果 不同处理组之间性别、吸烟、饮酒、高血压、糖尿病、心脏病、乙肝、丙肝、肝功能A级、B级的比率、年龄、体重、身高、脾脏长径及厚度、血小板、血红蛋白、白细胞、尿素氮、肌酐、总胆红素、谷草转氨酶、谷丙转氨酶、术中胶体液用量均无明显差异(P>0.05),在手术出血量、晶体液、输血人数、未输血人数方面、横结肠脾曲和胰尾损伤、手术总时间方面存在差异(P<0.05)。术后7天、1个月、3个月不同处理组之间出现左侧胸腔积液、脾窝局限性积液、左膈下积液、切口感染、脾热、胰瘘的比率以及脾窝血性引流量、白蛋白指标均无明显差异(P>0.05),而在谷草转氨酶、谷丙转氨酶指标方面存在差异(P<0.05);术后6个月所有观察指标间均无明显差异(P>0.05)。吸烟、饮酒、高血压、糖尿病、心脏病对于增加术中风险及术后并发症发生率未有显著影响(P>0.05),乙肝、丙肝对于增加术中风险及术后并发症发生率的概率是正常人群的4.21倍和4.33倍。结论 门静脉高压症合并脾功能亢进施行脾切除术是安全可行的,且随着医疗技术发展,较以往安全性有所提高,门静脉高压症所引起的上消化道出血应依据不同指征采取不同手术方式;既往乙肝、丙肝是增加术中风险及术后并发症发生率的影响因素。
Other AbstractObjective Cirrhosis of the liver, as one of the common causes of portal hypertension, leads to liver function compensatory,that could cause portal hypertension which is the most common cause of hypersplenism. Currently, the therapy approach of portal hypertension combined the hypersplenism is mainly surgery. In this study, Patients with portal hypertension combined the hypersplenism, who had a splenectomy at First Hospital Affiliated to Lanzhou University in January 2013 - December 2014 were taken as research objects to explore the relationship of splenectomy to portal hypertension combined the hypersplenism and perioperative safety and the influence of splenectomy on body. Methods Collect the data of 116 patients with portal hypertension combined the hypersplenism, who had a splenectomy at First Hospital Affiliated to Lanzhou University in January 2013 - December 2014. The splenectomy was divided into the simple splenectomy, disconnection, bypass surgery and disconnectioncombinedbypass surgery based on the indications for surgery. Observe preoperative and postoperative 7 days, 1 month, 3 months, 6months recovery and complications index. Results Among different groups,sex, smoking, alcohol consumption, hypertension, diabetes, heart disease, hepatitis B, hepatitis C, liver function A grade, B grade ratio, age, weight, height, diameter and thickness of the spleen, platelets, hemoglobin, white blood cells , urea nitrogen, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, intraoperative colloid fluid volume were not significantly different (P>0.05), however on the amount of bleeding during surgery, liquid crystals, the number of blood transfusions and no , the transverse splenic flexure and tail of the pancreas damage, there are differences (P<0.05) ontotal time surgical aspects. Left pleural effusion occurs, spleen nest limitations effusion, left subphrenic effusion, wound infection, splenic fever, the rate of pancreatic fistula and spleen nest bloody drainage, albumin index were not significantly different (P>0.05), while in aspartate aminotransferaseand alanine aminotransferase indicators, there are differences (P<0.05) among different groups,7 days, one month, and 3 months after surgery; Across all outcome measures after six months there was no significant difference (P >0.05). Smoking, alcohol consumption, hypertension, diabetes, heart disease don’t have significantly influenceon increasing the risk of intraoperative...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/224312
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
郭臣. 116例门脉高压症合并脾功能亢进施行脾切除术的安全性分析[D]. 兰州. 兰州大学,2015.
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