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目的评价脾切除术后抗病毒治疗对丙肝肝硬化患者肝脏储备及再出血风险的影响。方法收集长期随访资料完整的肝硬化脾切除患者的资料纳入回顾性统计分析。依照术后不同治疗方式分为两组:治疗组为抗病毒治疗42例和对照组为未抗病毒治疗33例。分别在治疗过程中6个不同时间点对各组患者凝血系列(APTT、PT、PTA、Fib)、肝脏功能(ALB、A/G)、PLT及门静脉宽度等主要指标进行统计分析。结果 PT在治疗组中的表达于术后60个月较抗病毒治疗前显著降低(P<0.01),延缓了PT时间;APTT在治疗组和对照组术后均即刻出现下降(P<0.05),但这种下降趋势于治疗组可保持到术后60个月,而对照组自术后6个月以后呈上升趋势;治疗组对PTA短期无改善,但术后60个月时较对照组差异有统计学意义(P<0.01);术后6个月时治疗组和对照组Fib值均为最高点,但治疗组与各时间点差异均无统计学意义;PLT在术后即刻升高且与术前比较差异有统计学意义(P<0.001),并随病程延长出现与ALB水平和A/G比值相同的先升后降趋势。治疗组较对照组能够使术后降低的门静脉宽度值和出血率延缓上升。结论肝硬化患者脾切除术后进行抗病毒治疗能够显著改善患者的凝血功能,降低再出血风险。
Objective To evaluate the effect of antiviral therapy after splenectomy on liver reserve and rebleeding risk in patients with hepatitis C cirrhosis. Methods The data of long-term follow-up data collection of patients with splenectomy for cirrhosis were included in the retrospective statistical analysis. According to the different postoperative treatment methods are divided into two groups: the treatment group for the antiviral therapy in 42 cases and the control group for the antiviral therapy in 33 cases. The main indexes of clotting series (APTT, PT, PTA, Fib), liver function (ALB, A / G), PLT and portal vein width were statistically analyzed at 6 different time points during the course of treatment. Results The expression of PT in the treatment group was significantly lower than that before antiviral therapy at 60 months after operation (P <0.01), and PT was prolonged. The APTT decreased immediately after operation in the treatment group and the control group (P <0.05) , But this trend of decline in the treatment group can be maintained to 60 months after surgery, while the control group from 6 months after surgery was an upward trend; treatment group did not improve PTA short-term, but 60 months after surgery compared with the control group The difference was statistically significant (P <0.01); 6 months after the treatment group and the control group Fib values ?? were the highest point, but the treatment group at any time point was no significant difference; PLT immediately after surgery increased (P <0.001). Compared with the preoperative, there was a trend of increasing first and then decreasing with ALB level and A / G ratio. The treatment group than the control group can reduce the postoperative portal vein width and bleeding rate increased slowly. Conclusions Antiviral therapy after splenectomy in patients with cirrhosis can significantly improve the coagulation function and reduce the risk of rebleeding.