选择性断流术治疗门静脉高压症217例  

Management of 217 portal hypertension cases using selective devascularization

作　　者：谢敏[1] 曹亚娟[1] 潘一明[1] 许碧云[2] 

机构地区：[1]南京大学医学院附属鼓楼医院普外科,江苏省南京市210008 [2]南京大学医学院附属鼓楼医院统计科,江苏省南京市210008

出　　处：《世界华人消化杂志》2008年第17期1938-1941,共4页World Chinese Journal of Digestology

摘　　要：目的:研究选择性断流术(选择性保留食管旁静脉的断流术)对门静脉高压症临床疗效的影响.方法:1993-01/2007-12收治门静脉高压症患者217例,分为3组:第1阶段(1993-01/1997-12)组27例,第2阶段(1998-01/2002-12)组68例和第3阶段(2003-01/2007-12)组122例,对不同组间食管旁静脉保留率、自由门静脉压变化、临床疗效等进行回顾性对比分析.结果:食管旁静脉的保留率第1阶段组33.3%,第2阶段组88.2%,第3阶段组93.4%,组间差异有统计学意义(P<0.05);与术前比较,3个阶段组术后自由门静脉压差值有统计学意义(F=5.22,P<0.01);术后近期并发症的发生率第1阶段组33.3%,第2阶段组14.7%,第3阶段组13.1%,差异有统计学意义(P<0.05);术后5年生存率从第1阶段组的74.1%,提高到第2阶段的91.2%,差异有统计学意义(P<0.05).结论:选择性断流术能够更有效降低门静脉压力、减少术后近期并发症、提高5年生存率.AIM： To determine efficacy ot seLective devascularization in management of portal hypertension through analysis of such variables as portal pressure, postoperative complications and survival rates, etc. METHODS： A total of 217 patients with portal hypertension admitted to our hospital Jan. 1993 to Dec. 2007 were divided into three groups based on 5-year blocks： stage 1 group （1993-01/1997-12）, stage 2 （1998-01/2002-12） and stage 3 group （2003-01/2007-12）. The clinical data concerning preoperative and postoperative differences in free portal pressure, preservation rate of paraesophageal varices, postoperative early complications and the 5-year survival rates were retrospectively analyzed. RESULTS： The preservation rates of para-esophageal varices were 33.3% in group 1, 88.2% in group 2 and 93.4% in group 3 and significant differences were detected among the three groups （P 〈 0.05）. Significant differences were also detected between preoperative and postoperative free portal pressure in each stage group （F = 5.22, P 〈 0.01）. Differences in incidence rates of post-operative early complications were significant among stage 1 （33.3%）, stage 2 （14.7%） and stage 3 （13.1%）（P 〈 0.05）. 5-year survival rates increased from 74.1% in stage 1 group to 91.2% in stage 2 group, indicating a significant difference（P 〈 0.05）. CONCLUSION： Selective devascularization lowers free portal pressure more effectively, reduces incidence rates of postoperative early complications and increases 5-year survival rates for patients with portal hypertension.

关 键 词：门静脉 高血压 断流术 食管旁静脉 自由门静脉压 

分 类 号：R657.3[医药卫生—外科学]