改良脾肺固定术后患者脾肺间侧支循环的建立及影响因素
Collateral circulation development and its influence between spleen and lung in patients after modified splenopneumopexy
目的 探讨改良脾肺固定术治疗门静脉高压症患者术后脾肺间侧支循环的建立情况及影响因素.方法 分析2009年1月至2014年12月收治59例患者的资料,应用彩超评估术后脾肺间侧支循环的建立情况.根据术后3个月的彩超结果分为明显侧支循环组(最大侧支直径≥2 mm,n=43)和无明显侧支循环组(最大侧支直径<2 mm,n=16),分析两组患者性别、年龄、疾病类型、Child-Pugh分级、自由门静脉压力、门静脉主干内径、脾静脉主干内径、脾动脉主干内径、脾脏长径、射血分数、一秒率、行部分脾切除及脾上极被膜处理方法.结果 本组59例患者中术后3个月有43例存在明显侧支,术后6个月有53例存在明显侧支,2组比较差异有统计学意义(x2=4.526,P<0.05).明显侧支循环组的脾脏长径(t=2.092)、一秒率(t=2.233)显著高于无明显侧支循环组(均P<0.05);2组患者的性别(x2=0.092)、年龄(t=-1.254)、疾病类型(x2=1.565)、Child-Pugh分级(Z=-1.821)、自由门静脉压力(t=0.912)、门静脉主干内径(t=0.008)、脾静脉主干内径(t=-0.485)、脾动脉主干内径(t=0.397)、射血分数(t=-0.852)、是否行部分脾切除(x2=0.002)及脾上极被膜处理方法(x2=1.731)均无统计学差异(均P>0.05).结论 门静脉高压患者经改良脾肺固定术治疗后脾肺间可形成明显侧支循环,其建立情况与脾脏长径及一秒率有关.
更多Objective To investigate the development and influence factors of collateral circulation between spleen and lung in patients with portal hypertension after modified splenopneumopexy.Methods Data of 59 patients from January 2009 to December 2014 were analyzed,and the development of collateral circulation between spleen and lung after surgery were evaluated with ultrasound.Patients were divided into obvious collaterals group (maximum collateral diameter ≥ 2 mm,n =43) and non-obvious collaterals group (maximum collateral diameter < 2 mm,n =16) according to ultrasound examination 3 months after surgery.Gender,age,type of disease,Child-Pugh classification,free portal pressure,portal vein diameter,splenic vein diameter,splenic artery diameter,splenic length,ejection fraction,forced vital capacity rate of one second (FEV1%),whether partial splenectomy was performed,and management of splenic upper pole were recorded and analyzed between the two groups.Results 3 months after surgery obvious collateral circulation could be observed in 43 patients,6 months after surgery the number increased to 53 (x2 =4.526,P < 0.05).Splenic length (t =2.092) and FEV1% (t =2.233) were significantly higher in obvious collaterals group (all P < 0.05),and there were no statistical differences in gender (x2 =0.092),age (t =-1.254),type of disease (x2 =1.565),Child-Pugh classification (Z =-1.821),free portal pressur (t =0.912),portal vein diameter (t =0.008),splenic vein diameter (t =-0.485),splenic artery diameter (t =0.397),ejection fraction (t =-0.852),whether partial splenectomy was performed (x2 =0.002),and management of splenic upper pole (x2 =1.731) between the two groups (all P > 0.05).Conclusions Obvious collateral circulation can develop between spleen and lung in patients with portal hypertension after modified splenopneumopexy,and the development of collateral circulation is associated with splenic length and FEV1%.
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