脾切除术联合门奇静脉断流术治疗肝硬化门静脉高压症患者系统性血流动力学紊乱：一项前瞻性单中心队列研究。

Splenectomy with Portoazygous Disconnection for Correction of Systemic Hemodynamic Disorders in Hepatic Cirrhosis Patients with Portal Hypertension: A Prospective Single-Center Cohort Study.

机构信息

General Surgery Department, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.

Institute and Hospital of Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Chinese PLA General Hospital, Beijing 100853, China.

出版信息

Can J Gastroenterol Hepatol. 2020 Dec 21;2020:8893119. doi: 10.1155/2020/8893119. eCollection 2020.

DOI:10.1155/2020/8893119

PMID:33415086

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7769657/

Abstract

OBJECTIVE

To investigate the effect of splenectomy for correction of systemic hemodynamic disorders in hepatic cirrhosis patients with portal hypertension.

METHODS

Hepatic cirrhosis patients with portal hypertension were enrolled from April 2015 to July 2018. Systemic hemodynamic parameters (heart rate, mean arterial pressure (MAP), cardiac output, and total peripheral vascular resistance (TPR)) were prospectively measured at baseline and 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. Paired analysis was conducted.

RESULTS

Sixty-nine patients were eligible, and 55 (79.7%) cases had a history of upper gastrointestinal bleeding. Child-Pugh classification was grade A in 41 (59.4%) cases, grade B in 26 (37.7%) cases, and grade C in 2 (2.9%) cases. The heart rate was significantly higher at 1 week postoperatively versus the baseline ( < 0.001). Meanwhile, the heart rate was significantly lower from 3 months to 2 years postoperatively versus the baseline ( < 0.05). The MAP was significantly higher at 6 months to 2 years postoperatively versus the baseline ( < 0.05). At 1 month postoperatively and 6 months to 2 years, the cardiac output was significantly lower versus the baseline ( < 0.05). At 1 month postoperatively and 6 months to 2 years, the TPR was significantly higher versus the baseline ( < 0.05).

CONCLUSION

Splenectomy corrects systemic hemodynamic disorder in hepatic cirrhosis patients with portal hypertension, and the effect is rapid and durable.

摘要

目的

探讨脾切除术纠正门静脉高压症肝硬化患者全身血流动力学紊乱的效果。

方法

2015 年 4 月至 2018 年 7 月期间，连续纳入门静脉高压症肝硬化患者，前瞻性测量患者基线时及术后 1 周、1、3、6 个月和 1、2、3 年的全身血流动力学参数（心率、平均动脉压（MAP）、心输出量和总外周血管阻力（TPR））。采用配对分析。

结果

共纳入 69 例患者，其中 55 例（79.7%）有上消化道出血史。Child-Pugh 分级为 A 级 41 例（59.4%），B 级 26 例（37.7%），C 级 2 例（2.9%）。术后 1 周心率明显高于基线（<0.001）。同时，术后 3 个月至 2 年心率明显低于基线（<0.05）。术后 6 个月至 2 年 MAP 明显高于基线（<0.05）。术后 1 个月和 6 个月至 2 年心输出量明显低于基线（<0.05）。术后 1 个月和 6 个月至 2 年 TPR 明显高于基线（<0.05）。