【摘要】 目的　探讨门静脉高压症脾切除术后持续性发热的原因及处理方法。方法　收集 1 3年间 2 9 5例行门静脉高压症手术伴脾切除术病例的临床资料,对其中 8 0例术后体温高于 3 8. 5℃,持续性发热 2周以上的发热原因和处理进行分析。结果　除 2例发热原因不明外,术后发热均由各种并发症引起,其中门脾静脉血栓形成 3 5例,脾窝积血、积液合并感染 2 0例,左膈下感染 7例,肺炎、胸腔积液或积脓 5例,术后胰尾部脓肿、泌尿系感染、切口感染各 3例,食管吻合口瘘 1例,腹腔感染 1例。持续性发热与肝功能分级有关 (P< 0. 0 1 ),与术式无关 (P > 0. 0 5 )。门脾静脉血栓形成与术式选择无关 (P> 0. 0 5 )。结论　 门脾静脉血栓形成及脾窝积血、积液或感染是术后持续性发热的主要原因。防治各种感染及改善肝功能可有效地减少术后持续性发热。更多还原

【Abstract】 Objective To investigate the cause and management of postsplenectomy fever in portal hypertensive patients . Methods The clinical data of 295 portal hypertension patients undergoing splenectomy from 1990 to 2003 were reviewed. Among these,80 patients suffered from a continuous fever higher than 38.5℃ for more than 2 weeks postoperatively. Results Except for two patients with unknown cause, 78 of 295 patients with continuous fever were caused by complications such as splenoportal thrombosis(35 cases), infection of hematocele or hydrops in splenic recess(20 cases), left subphrenic infection(7 cases), pneumonia and hydrothorax or empyema(5 cases), 3 cases each of postoperative abscess of tail of pancreas,winary tract infection and inteclion of surgical incision, 1 case of leakage of esophageal anastomosis and intraabdominal infection in 1 case. The lasting fever was related to the grade of liver function(P<0.01). The surgical modality adopted was not related to the continuous fever or splenoportal thrombosis(P>0.05). Conclusions Splenoportal thrombosis, and hematocele, hydrops or infection in the splenic recess were the main causes of persistent fever after splenectomy. Prevention and treatment of infection and amelioration of hepatic function will help to reduce the rate of postoperative continuous fever.更多还原