选择性脾胃区减断分流术治疗门静脉高压症  

Selective decongestive devascularization shunt of gastrosplenic region for treatment of portal hypertension

作　　者：张启瑜[1] 陶崇林[1] 朱千东[1] 周蒙滔[1] 廖毅[1] 余正平[1] 施红旗[1] 

机构地区：[1]温州医学院附属第一医院肝胆外科,浙江325000

出　　处：《中华肝胆外科杂志》2010年第2期119-121,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨选择性脾胃区减断分流术治疗肝硬化门静脉高压症的临床应用。方法2000年9月至2008年6月间采用选择性脾胃区减断分流术治疗门静脉高压症44例，其中29例随访12~85个月，平均44个月。结果（i）无术中大出血和病死病例，区域性减压显著；（2）术后近期轻度脾梗塞3例，并发乳糜漏3例；（3）近期肝性脑病发生率2．27％（1／44），再发出血率0％；远期肝性脑病发生率3．45％（1／29），再发出血率3．45％（1／29）；（4）远期脾脏显著缩小，血小板显著升高（P〈O．01）。结论选择性脾胃区减断分流术疗效可靠，可作为治疗门静脉高压症的理想术式。Objective To evaluate the curative effect of selective decongestive devascularization shunt of gastrosplenic region（SDDS-GSR） for the treatment of portal hypertension. Methods From September 2000 to June 2008, 44 patients with portal hypertension had received SDDS-GSR in our hospital. Twenty-nine of them had been followed up for 12-85 months （mean= 44months）. Results Operative mortality was 0 ~. Mesenteric area pressure（33.82--＋-_ 5.12 em H2 O）was higher than splenic area pressure（24.57＋4.63 em H20）soon after the operation finished（P^0.01）. No re-bleeding ca- ses were found, and the encephalopathy occurred in 2.27% of the patients in the early stage of post- operation. However, the rates of 3.45 % for re-bleeding and 3.45% for eneephalopathy were noticed in long-term follow-up. The 1-, 3- and 5-year survival were 100%, 95% and 95%, respectively. Dur- ing the long-term follow-up, the platelet counts markedly increased from （49.2±21.8）× 10^/L） of preoperative value to （77.2±29.5 × 10^9/L） （P〈0.01）, while spleen size was significantly reduced. Conclusion SDDS-GSR is a reliable and reasonable surgical procedure for the management of portal hypertension.

关 键 词：高血压 门静脉 远端脾肾分流术 脾动脉 疗效 

分 类 号：R657.3[医药卫生—外科学]