联合断流术术式的改进及其疗效的评价  

A new modified Sugiura procedure for portal hypertension： an outcome analysis of 174 cases

作　　者：胡国华[1] 顾大镛[1] 郑烈伟[1] 徐维刚[1] 吴肇光[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中华普通外科杂志》2007年第3期197-199,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨一种新的联合断流术治疗门静脉高压症引起的食管下端胃底曲张静脉破裂出血的安全性和有效性。方法 1995年5月至2005年5月本院共对174例门静脉高压症患者施行了联合断流术，即脾切除、贲门周围血管离断和胃壁肌层、黏膜下层的血流阻断，后者应用吻合器或闭合器来完成。回顾分析其临床资料、手术方式、术后并发症、死亡率以及长期随访的结果。结果 本组患者平均手术时间（3．9±1．0）h，平均输血量（598±650）ml，其中32．8％未输血，术后平均住院（17±7）d。术后并发症发生率为11．5％，手术死亡率为2．3％，无肝性脑病的发生。随访147例（86．5％），平均随访时间（36±23）个月。远期再出血率、肝性脑病发生率和死亡率分别为15．0％、2．0％和4．8％。结论 应用该术式后患者发生并发症少，死亡率低，远期疗效满意，是防治门静脉高压症引起的食管下端胃底曲张静脉破裂出血的理想术式。术后加强胃黏膜的保护，止酸、抑酸对防治再出血有着积极的意义。Objective To investigate the safety, rationality and efficacy of a new modified Sugiura procedure in the treatment of esophagogastric variceal bleeding caused by portal hypertension. Methods The clinical data, operative pattern, post-operative complication rate, mortality and outcomes of 174 portal hypertension cases who underwent this modified Sugiura procedure between May 1995 and May 2005 were retrospectively analyzed. This procedure included splenectomy, pericardial devascularization and blocking the blood flow of gastric fundal varices by the means of linear cutters or staplers. Results The average operative time, blood transfusion and hospital stay in the group were （3.9 ± 1.0） h, （598 ± 650） ml and （ 17 ±7） d, respectively. The post-operative complication rate and mortality was 11.5% and 2.3%, respectively. One hundred and forty-seven cases （86. 5% ） were followed up for an average of （36 ± 23） months, the incidence of rebleeding, hepatic encephalopathy and mortality was 15.0%, 2.0% and 4. 8%, respectively. Conclusion This new modified Sugiura procedure is a rational surgical procedure in the treatment of portal hypertension.

关 键 词：高血压 门静脉 食管和胃静脉曲张 手术后并发症 断流术 

分 类 号：R686[医药卫生—骨科学]