门奇断流术后食道静脉曲张复发及出血相关因素分析  

Clinical risk factors analysis of recurrence of esophageal varices and varix bleeding after esophagogastric devascularization.

作　　者：刘续宝[1] 张刚[1] 张肇达[1] 严律南[1] 金立人[1] 饶林强[1] 蒲克 

机构地区：[1]华西医科大学附属第一医院普外科

出　　处：《中国实用外科杂志》1997年第8期466-468,共3页Chinese Journal of Practical Surgery

摘　　要：对１９８９～１９９５年成功实施门奇断流术的１２０例肝硬变门静脉高压症病人进行了追踪调查，８５例（７０．８３％）获得随访。调查发现，食道静脉曲张复发率为１００％，术后发生出血２０例，出血和曲张程度与术前静脉曲张程度、门静脉压力明显相关；且术前有出血史者术后出血的机会明显增大，而与术前肝功能情况无明显关系。建议对门静脉压＞３．６０ｋＰａ的重度食道静脉曲张病例，尤其有出血史者，作门奇断流术时宜同时作小口径门腔分流术。而对于无出血史的轻度食道静脉曲张病例，门静脉压亦较低，预防性门奇断流术的价值不大，并可能加重食道静脉曲张程度。To determine the some clinical potential risk factors of recurrence of esophageal varices and varix bleeding after surgery with esophagogastric devascularization(Hassab procedure),120 cirrhotic patients with portal hypertension were followed up after surgery during past six years from 1989 to 1995.Among 85 cases gotten in the following up,postoperative varix bleeding occurred in 20 patients and recurrent varices were seen in all patients.This study indicated that postoperative recurrent varices in esophagus and varix bleeding is correlated with preoperative situations of varices and portal pressure,and without the leisure of hepatic functions.Moreover,for these cases with a history of varix bleeding,the likelihood of postoperative varix bleeding is larger than those ones without the same history.So we suggest that small bore portacaval shunt should be performed simultaneously while esophagogastric devascularization was done for these cirrhotic patients with severe esophageal varices and higher(more than 3 60kPa),especially with a history of varix bleeding.However it is not of valuable and perhaps will deteriorate varices if prophylactic esophagogastric devascularization was performed for these with light esophageal varices and lower portal pressure,especially without a history of varix bleeding.

关 键 词：门奇断流术 食管静脉曲张 出血 门脉高血压 

分 类 号：R657.340.5[医药卫生—外科学] R571.3[医药卫生—临床医学]