隧道式贲门周围血管离断术治疗门静脉高压症307例疗效分析  

Tunnel pericardial devascularization on upper gastrointestinal bleeding for portal hypertension patients:an analysis of 307 cases

作　　者：马建仓[1] 赵军[1] 李宗芳[1] 陈亮[1] 张大华[1] 苏清华[1] 纪宗正[1] 

机构地区：[1]西安交通大学医学院第二附属医院普通外科,陕西西安710004

出　　处：《中国实用外科杂志》2008年第4期280-282,共3页Chinese Journal of Practical Surgery

摘　　要：目的评价隧道式贲门周围血管离断术治疗门静脉高压症尤其是上消化道出血的近、远期疗效。方法回顾性分析西安交通大学医学院第二附属医院普通外科1995年9月至2005年12月收治的307例门静脉高压症病人的临床资料。所有病人均行隧道式贲门周围血管离断术,随访观察该术式的近、远期疗效。结果术后止血率为97.69%,围手术期病死率为4.23%,主要死因有上消化道出血、腹腔内出血、肝衰、肝肾综合征。共有63例(20.63%)病人出现近期并发症。随访病例248例,平均随访时间(50±6)个月。术后5年再出血发生率为3.41%,10年再出血发生率为11.93%。结论该术式治疗门静脉高压症尤其是上消化道出血近、远期疗效可靠,严重并发症少。Objective To evaluate the recent and proposed effects of tunnel pericardial devascularization in portal hypertension patients especially with upper gastrointestinal bleeding. Methods The clinical data of 307 cases of portal hypertension admitted from September 1995 to December 2005 in the 2nd Affiliated Hospital of Xi＇ an Jiaotong University were analyzed retrospectively. All the cases were performed tunnel pericardial devascularization. The recent and proposed effects were observed during the follow-up period, Results Two hundreds and eleven cases （211/216,97. 69 % ） of upper gastrointestinal bleeding were controlled, The perioperative mortality rate was 4, 23%, The main causes of death included upper gastrointestinal bleeding, intra-abdominal hemorrhage, hepatic failure and hepatorenal syndrome. Early complications occurred in 63 cases （20. 63 % ）. Two hundreds and forty-eight cases were followed up. The mean follow-up peroid was （ 50 ± 6） months. There were 6 cases （ 3. 41% ） of recurrent upper gastrointestinal bleeding in following 5 years and 21 cases （ 11.93% ） in 10 years. Conclusion Tunnel pericardial devascularization is effective in the treatment of upper gastrointestinal bleeding for portal hypertension patients. There is few early or proposal serious complication occurrence.

关 键 词：肝硬化 门静脉高压症 断流术 

分 类 号：R657.34[医药卫生—外科学] R776.105[医药卫生—临床医学]