紧贴胃食管壁的贲门周围血管离断术联合涤纶片覆盖治疗食管胃底静脉曲张  

Flow-breaking of pericardial blood vessel and polyester flake on varices of esophagus and fundus of stomach

作　　者：俞景奎[1] 

机构地区：[1]滕州市中心人民医院,山东滕州277500

出　　处：《山东医药》2005年第9期5-7,共3页Shandong Medical Journal

基　　金：枣庄市科技局科技发展计划项目 (No.2 0 0 4-64 1)

摘　　要：目的　探讨食管胃底静脉曲张的有效治疗方法。方法　将需施行贲门周围血管离断术的食管胃底静脉曲张患者6 1例随机分成两组。对照组30例,采用传统脾切除术+贲门周围血管离断术;观察组31例,在脾切除术后,紧贴胃食管壁行贲门周围血管离断术,保留自胃冠状静脉→食管旁静脉丛→奇静脉的侧支通畅;创面用生物胶止血,将医用涤纶片覆盖在剥离后的食管下段、胃底。结果　术后3、5年,两组食管静脉曲张程度均有明显差异(P <0 .0 1,P <0 .0 5 ) ;食管胃底静脉曲张再破裂出血率,观察组分别为6 .5 % (2 / 31)、9.7% (3/ 31) ,对照组分别为30 % (9/ 30 )、5 3.3% (16 / 30 ) ,两组相比均有明显差异(P <0 .0 5 ,P <0 .0 1)。术后5年食管胃底静脉曲张再破裂出血致死率,观察组为3.2 % (1/ 31)、对照组为2 3.3% (7/ 30 ) ,两组相比P <0 .0 5。结论　紧贴胃食管壁的贲门周围血管离断术联合涤纶片覆盖,能有效阻止食管胃底周围新生侧支循环的建立,明显降低贲门周围血管离断术后食管、胃底静脉曲张再破裂出血率。Objective To study the curative therapy of varices of esophagus and fundus of stomach.Methods 61 patients who needed flow-breaking of pericardial blood vessel we re divided r andomly into two groups.In control group(30 cases),traditional splenectomy plu s flow-breaking of pericardial vessel was performed.In observation group(31 ca s es),after splenectomy,flow-breaking of pericardial vessel was done close to w all of esophagus and stomach and collateral branch from coronary vein of stomach →paravenous plexus of esophagus→odd vein were kept clear.Biocholloid was used on wound surface for hemostasis and the lower part of esophagus and fundus of s tomach detached was covered with medical polyester flake.Results 3 and 5 years after operation,there were both significant differences (P<0.01,P <0.05,r espectively) in esophagus varices between the two groups.Recurrent rates of rup ture and hemorrhage of varices of esophagus and stomach fundus in observation gr oup were 6.5%(2/31)and 9.7%(3/31),respectively while those in Control group w ere 30% (9/30) and 53.3% (16/30).There were significant differences (P<0 .05 ,P<0.01,respectively) between the two groups,5 years after operation, death rates of recurrent rupture and hemorrhage of varices of esophagus and stomach f undus in observation group was 3.2% (1/31)while that in control group was 23. 3% (7/30),P<0.05.Conclusion Flow-breaking of pericardial blood vessel close to wall of stomach and esophagus combined with polyester flake covering may eff ectively stop establishment of new collateral circulation around esophagus and s tomach fundus,markedly reduce recurrent rate of rupture and hemorrhage of varic es of esophagus and stomach fundus after flow-breaking of pericardial vessel.

关 键 词：贲门周围血管离断术 食管胃底静脉曲张 涤纶片 食管壁 覆盖 食管静脉曲张程度 脾切除术后 胃冠状静脉 治疗方法 食管下段 破裂出血 侧支循环 对照组 观察组 出血率 再破裂 奇静脉 静脉丛 食管旁 胶止血 致死率 组分 相比 

分 类 号：R657.34[医药卫生—外科学] R571.3[医药卫生—临床医学]