中华肝脏外科手术学电子杂志2016，Vol.5Issue(3)：135-140,6.DOI:10.3877/cma.j.issn.2095-3232.2016.03.003
CT门静脉成像分型个体化手术治疗在肝硬化门静脉高压症中的应用价值
Application value of individualized surgical treatment based on CT portal venograpy classiifcation in cirrhotic portal hypertension
摘要
Abstract
ObjectiveTo explore the application value of individualized surgical treatment based on the CT portal venograpy (CTPV) classiifcation in cirrhotic portal hypertension.MethodsOne hundred and iffty-six patients with cirrhotic portal hypertension who received surgical treatment in Anhui Province Hospital between June 2010 and December 2014 were enrolled in this prospective study. According to different surgical procedures, the patients were divided into two groups: the individualized surgery based on CTPV classiifcation group (classification group) and traditional surgery group (traditional group). Among the 84 patients in the classiifcation group, 56 were males and 28 were females with the age ranging from 19 to 67 years old and the median of 45 years old. Among the 72 patients in the traditional group, 47 were males and 25 were females with the age ranging from 23 to 62 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients in the classiifcation group underwent individualized surgery according to the pre-operative CTPV classiifcation, while the patients in the traditional group underwent splenectomy + pericardial devascularization. The effects of two surgical procedures on the portal hypertension, intraoperative and postoperative conditions and postoperative survival rate of the patients were observed. The observation indexes of two groups were compared usingt test and survival analysis was conducted using Kaplan-Meier method and Log-rank test.ResultsThe postoperative free portal pressure (FPP) in the classiifcation group was (27±3) cmH2O (1 cmH2O=0.098 kPa), signiifcantly lower than (33±8) cmH2O in the traditional group (t=-3.355,P<0.05). The FPP decrease range before and after surgery in the classiifcation group was (13±6) cmH2O, signiifcantly higher than (9±5) cmH2O in the traditional group (t=3.016,P<0.05). The length of surgery and intraoperative blood loss in the classiifcation group were respectively (188±84) min and (378±49) ml, significantly less than (240±76) min and (463±57) ml in the traditional group (t=-2.687,-3.015;P<0.05). The postoperative length of stay and hospitalization expense in the classiifcation group were respectively (12±4) d and (31 000 ± 15 000) yuan, signiifcantly lower than (15±5) d and (36 000±15 000) yuan in the traditional group (t=-2.061,-2.104;P<0.05). The 1, 3-year accumulative survival rate were respectively 94.05% and 85.71% in the classiifcation group, and were respectively 87.50% and 68.05% in the traditional group. The overall survival rate in the classiifcation group was signiifcantly higher than that in the traditional group (χ2=7.000,P<0.05).ConclusionsPre-operative CTPV classification and individualized surgical treatment for patients with cirrhotic portal hypertension can effectively reduce the portal vein pressure and has the advantages of smaller injury and better prognosis.关键词
体层摄影术,螺旋计算机/个体化医学/肝硬化/高血压,门静脉Key words
Tomography, spiral computed/Individualized medicine/Liver cirrhosis/Hypertension, portal引用本文复制引用
余继海,张努,邵峰,马杰,许戈良,马金良,荚卫东,李建生,葛勇胜,刘文斌,张传海,胡宇..CT门静脉成像分型个体化手术治疗在肝硬化门静脉高压症中的应用价值[J].中华肝脏外科手术学电子杂志,2016,5(3):135-140,6.基金项目
安徽省卫生厅医学科研课题项目 （）
