贲门周围血管离断术联合分流术治疗食管-胃底曲张静脉破裂出血  

Peri-cardiac devascularization combined with decompression to treat gastroesophageal varices bleeding

作　　者：张珂[1,2] 纪旭[1] 王洪波[1] 常伟华[1] 任辉[1] 赵妮娜[1] 李志伟[1] 

机构地区：[1]解放军第302医院外科,北京100039 [2]首都医科大学朝阳医院在职业博士生

出　　处：《实用医学杂志》2005年第4期370-372,共3页The Journal of Practical Medicine

摘　　要：目的:了解和评价贲门周围血管离断术联合分流术治疗食管-胃底曲张静脉破裂出血的临床效果。方法:对23例门静脉高压症食管-胃底曲张静脉破裂出血患者行贲门周围血管离断术联合脾-腔分流、脾-肾分流、肠-腔侧侧分流,手术前后测量自由门静脉压(FPP),观察术后肝功能、再出血率及并发症发生情况,彩色多谱勒超声观察门静脉血流,胃镜了解曲张静脉缓解情况。结果:手术前后比较,术后FPP有明显下降(P<0.01),术后彩色多谱勒超声测定门静脉血流速度、门静脉血流量较术前下降,尽管统计学比较差异有显著性(P<0.05),但门静脉仍然维持有效向肝血供,术后胃镜提示曲张静脉消失情况满意,术后无严重并发症发生,随访1～3年肝功能稳定,无再出血病例。结论:该术式具有良好的近远期治疗效果,对于肝功能分级为ChildA、B级的患者可以考虑行联合手术。Objective To evaluate the clinic effects of peri cardiac devascularization combined with decompression in treating gastroesophageal varices bleeding. Methods Twenty three patients of portal hypertension having gastroesophageal varices bleeding were accepted peri cardiac devascularization combined with splenic renal shunt, splenic caval shunt, or side to side mesocaval shunt respectively. Free portal vein pressure(FPP) was measured during the operation. After operation, liver function, operational complications and recurrence of gastroesophageal varices bleeding were observed, as well as resorting color doppler flow imaging and endoscopy to know whether portal vein had effective blood supplements or gastroesophageal varices were disappeared. Results Twenty three patients did not have serious complaints after operation. Through 1～3 years follow up, they had steady liver function and did not recur gastroesophageal varices bleeding. Compared with preoperation, FPP, blood velocity and blood flux of portal vein had significantly decreased (P< 0.05, 0.05 and 0.05, respectively) postoperatively. However, portal vein was still imbued with enough blood directing to liver tissue at the same time. Gastroesophageal varices had a tendency to vanish step by step. Conclusions The peri cardiac devasculariation combined with decompression in treating gastroesophageal varices bleeding has a better effect in the near or long dated future. Consequently, the patients of gastroesophageal varices bleeding could be treated with this surgical therapy on condition that they have Class Child A or B.

关 键 词：曲张静脉 治疗 胃底 术后 破裂出血 食管 贲门周围血管离断术 结论 分流 情况 

分 类 号：R657.3[医药卫生—外科学]