肝豆状核变性合并脾功能亢进患者 脾切除临床观察.

Objective To investigate the benefits and risks of splenectomy in adult patients with hepatolenticular de⁃ generation (HLD)and hypersplenism. Methods A total of 100 adult patients with liver cirrhosis and hypersplenism were collected and were divided into the HLD group of 50 cases and the viral hepatitis B (HBV) group of 50 cases. Patients in both groups received splenectomy, and the operation time, intraoperative blood loss and postoperative drainage volume were recorded, and intraoperative MAP, HR, and SPO2 were monitored. Fasting venous blood was collected at 1 day before surgery and 1, 7, and 14 days after surgery. We used an automatic blood cell analyzer to detect WBC, RBC, PLT and Hb, and used automatic biochemical analyzer to detect liver function indexes AST, ALT, TBIL and ALB. The incidence of postoperative complications (including intraabdominal hemorrhage, pancreatic leakage, portal vein system thrombosis (PVST), incision complications, pulmonary infection and urinary tract infection)were observed, and the mortality rate at discharge was calculated. Results There were no significant differences in operation time, intraoperative blood loss, postoperative drainage, MAP, HR, or SPO2 at different time points during the operation between the two groups (all P>0. 05). The postoperative WBC in both groups was higher than that before operation, reaching the highest point on the 1st day after operation, and gradually decreased to the normal range on the 7th and 14th days after operation (all P<0. 05)；postoperative RBC, Hb, and PLT in both groups were higher than those before surgery, and those on the 7th and 14th days after surgery were higher than those on the 1st day after surgery, and those on the 14th day after surgery were higher than those on the 7th day after surgery (all P<0. 05). The levels of ALT, AST and TBIL in the two groups in⁃ creased on the 1st day after operation in comparison with those before operation, decreased to the preoperative level on the 7th day after operation, and continued to decrease on the 14th day；on the 1st day after operation, ALB decreased com⁃ pared with that before operation, increased to the preoperative level on the 7th day after operation, and continued to increase on the 14th day after operation (all P<0. 05). Six cases in the HBV group and 9 cases in the HLD group had surgical complications, and the complication grades were all grade I. There was no significant difference in the incidence of complications between the two groups (P>0. 05). There were no deaths in either group. Conclusions Splenectomy for HLD complicated with hypersplenism not only achieves the expected curative effect, but also improves postoperative liver function. In comparison with patients with hypersplenism caused by other diseases who undergo splenectomy, the pa⁃ tients’postoperative complications and mortality do not increase, and their intraoperative vital signs are stable. [ABSTRACT FROM AUTHOR]