选择性和非选择性断流术治疗门静脉高压症的疗效观察  

Comparative therapeutic effects of selective and non-selective devascularization procedures in the surgical treatment of portal hypertension

作　　者：潘万能[1] 张清华[1] 张雪峰[1] 徐刚[1] 叶宇[1] 

机构地区：[1]浙江省杭州市第六人民医院肝胆外科,浙江杭州310014

出　　处：《外科理论与实践》2009年第1期21-23,共3页Journal of Surgery Concepts & Practice

基　　金：杭州市科技发展计划(20080333Q12)

摘　　要：目的:探讨选择性和非选择性断流术对门静脉高压症的治疗作用。方法:将176例肝硬化门静脉高压上消化道出血病人随机分为选择性断流术组(观察组,91例)和非选择性贲门周围血管离断术组(对照组,85例)。结果:脾脏切除前、后两组间自由门静脉压力(FPP)无差异(P>0.05);术毕时对照组FPP为(29.8±5.1)cmH2O,观察组为(26.4±5.2)cmH2O(P<0.05)。术后6个月观察组的肝功能Child-Pugh评分、腹水、肝动脉血流量、胃底食管下段曲张静脉程度、门静脉高压性胃病及肝源性溃疡的发生率均优于对照组(P<0.05)。结论:选择性断流术合理地保留了机体的自发性分流,使入肝血量与降低门静脉压力这对矛盾达到动态平衡,是一种较理想的断流术式。Objectives To evaluate comparatively the therapeutic effects of selective and non-selective devaseularization procedures in the surgical treatment of portal hypertension. Methods A total of 176 cases of hepatic cirrhosis with portal hypertension guided by united selection and exclusion criterias were randomly divided into 2 groups： 91 patients were submitted to selective devascularization procedure（observation group）, and 85 patients were non-selectively submitted to the perieardial devascularization procedure（control group）. Results No significant difference of free portal pressure（FPP） was shown between the 2 groups before and after splenectory（P〉0.05）. The FPP was （29.8±5.1）cm H2O in the control group, and （26.4±5.2）cm H2O in the observation group at the end of the operation（P〈0.05）. The Child-Pugh scores, presence of ascites, the hepatic artery blood flow, the degree of gastroesophageal variees, the incidence of portal hypertention gastropathy and ulcer were relatively better in the observation group than those in the control group （P〈0.05） 6 months after operation. Conclusions The selective devascularization procedure reasonably preserves the patient＇s spontaneous capacity of blood diversion, thus helps achieving a dynamic balance between guaranteeing blood flow into the portal vein and reduction in the portal vein pressure. This appears to be an ideal procedure in the treatment of portal hypertension.

关 键 词：高血压 门静脉 选择性断流术 治疗结果 对比研究 

分 类 号：R657.34[医药卫生—外科学]