分流加断流术治疗门静脉高压症的疗效分析  

Combination of shunt procedure with portal azygous devascularization for portal hypertension

作　　者：赵浩亮[1] 王瑞智[2] 韩振国[1] 鲍民生[1] 

机构地区：[1]山西医科大学第一医院普外科,太原030001 [2]山西省肿瘤医院外科

出　　处：《中华普通外科杂志》2006年第10期692-694,共3页Chinese Journal of General Surgery

摘　　要：目的探讨近端脾肾静脉分流加贲门周围血管离断术治疗门静脉高压症的临床疗效及其对门静脉血流动力学的影响。方法回顾性分析我科1990年1月-2003年7月期间采用近端脾肾静脉分流加贲门周围血管离断术治疗门静脉高压症患者44例及单纯贲门周围血管离断术114例的临床资料,对其中部分患者采用彩色多普勒超声和术中自由门静脉压测量,观察手术前后门静脉系统血流动力学的变化。结果联合手术组无近期再出血,手术死亡率4．5％,远期再出血率8．3％,肝性脑病发生率5．5％,术后1、3、5、10年生存率分别为97．2％、91．2％、76．0％、64．3％;断流术组无近期再出血,手术死亡率4．3％,远期再出血率13．0％,肝性脑病发生率4．4％,术后1、3、5、10年生存率分别为96．7%、86．7％、71．8％、56．3％。联合手术组术后自由门静脉压和门静脉血流量分别下降(8±4)cmH2O和(511±152)ml／min,较术前相比差异有统计学意义(P<0．01),但仍接近和保持正常高限及一定向肝血流;断流术组自由门静脉压及门静血流量虽有一定降低与减少,但与手术前相比差异无统计学意义(P>0．05)。结论分流加断流术治疗门静脉高压症的临床疗效比较满意,具有血流动力学的合理性。Objective To investigate the effects of proximal spleno-renal shunt （PSRS）combined with pericardial devascularization （PCDV） on hemodvnamics of portal venous system. Methods From January 1990 to July 2003, 44 cases of portal hypertension were treated by PSRS ＋ PCDV in which Doppler color flow imaging （DCFI） and free portal pressure （FPP） were measured perioperatively. Results were compared with 114 cases treated by PCDV only. Results There was no short term rebleeding in group PSRS ＋ PCDV, and the incidence of rebleeding was 8.3% during a long term follow-up, The operative mortality was 4. 5%. The rate of hepatic encephalopathy was 5.5% postoperatively, and the long term survival rate of 1,3,5 and 10-year was 97.2% ,91.2% ,76. 0% and 64.3% respectively. There was no short-term rebleeding in group PCDV. The operative mortality was 4. 3%. The long term rebleeding rate was 13.0%. The rate of hepatic encephalopathy was 4. 4%. The postoperative survival rate of 1,3,5 and 10-year was 96.7% ,86. 7% ,71.8% and 56. 3%. In group PSRS ＋ PCDV, the portal vein flow rate（PVF） and FPP decreased by （511± 152） ml/min （34% ±6% ） and （8 ±4） cmH20 （21%±9%） respectively （P 〈0. 01 ） ,which still remained within the normal upper limit. Though FPP and PVF decreased in group PCDV, they did not differ apparently comparing with preoperation （P 〉0. 05 ）. Conclusion The combined procedure is a rational and practical operation in the treatment of portal hypertension.

关 键 词：高血压 门静脉 脾肾分流术 外科 断流术 血流动力学 

分 类 号：R657.3[医药卫生—外科学]