改良脾腔静脉分流联合断流术治疗食管胃底静脉曲张破裂出血  

Modified splenocaval shunt combined with pericardial devaseularization in the treatment of gastroesophageal variceal bleeding

作　　者：杜立学[1] 吴武军[1] 张煜[1] 张智勇[1] 李晖[1] 孙中杰[1] 胡海田[1] 刘青光[2] 

机构地区：[1]陕西省人民医院肝胆外科,西安710068 [2]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华消化外科杂志》2010年第4期276-279,共4页Chinese Journal of Digestive Surgery

基　　金：陕西省科学技术研究发展计划（2010K15-03）

摘　　要：目的 探讨改良脾腔静脉分流联合贲门周围断流术治疗门静脉高压症食管胃底静脉曲张破裂出血的临床疗效.方法 回顾性分析1997年至2007年陕西省人民医院采用改良脾腔静脉分流联合贲门周围血管断流术（90例,联合组）及贲门周围血管断流术（78例,断流组）治疗门静脉高压症食管胃底静脉曲张破裂出血患者的临床资料,应用彩色多普勒超声、术中门静脉压力监测等观察开腹后和术后门静脉系统血流动力学变化.采用方差分析及配对t检验和Х^2检验分析相关数据.结果 联合组和断流组患者手术死亡率分别为3%（3/90）和5%（4/78）,其差异无统计学意义（Х^2=0.038,P＞0.05）;术后远期出血率分别为6%（5/79）和13%（8/60）,其差异有统计学意义（Х^2=4.824,P〈0.05）;肝性脑病发生率分别为6%（5/79）和7%（4/60）,其差异无统计学意义（Х^2=0.072,P＞0.05）;术后1、3、5、10年生存率分别为97%（77/79）、92%（55/60）、80%（16/20）、60%（3/5）和97%（58/60）、83%（40/48）、73%（22/30）、53%（8/15）,其差异无统计学意义（Х^2=0.731,P＞0.05）.联合组开腹后和术后门静脉压力分别为（38.8±4.2）、（33.1±1.5）cm H2O（1 cm H2O=0.098 kPa）,其差异有统计学意义（t=8.574,P〈0.05）;断流组开腹后和术后门静脉压力分别为（38.9±2.5）、（34.6±2.6）cm H2O,其差异有统计学意义（t=6.530,P〈0.05）;两组患者术后门静脉压力比较差异有统计学意义（t=2.859,P〈0.05）.联合组开腹后和术后门静脉直径分别为（1.40±0.41）、（1.22±0.15）cm,其差异有统计学意义（t=2.608,P〈0.05）;血流量分别为（1280±350）、（830±360）ml/min,其差异有统计学意义（t=5.668,P〈0.05）.断流组开腹后和术后门静脉直径分别为（1.41±0.32）、（1.27±0.32）cm,其差异无统计学意义（t=1.637,P＞0.05）;血流量分别为（1350±380）、（980±290）ml/min,其差异有统计学�Objective To investigate the clinical effects of a modified splenocaval shunt combined with pericardial devascularization （ PCDV ） in the treatment of gastroesophageal variceal bleeding. Methods From 1997 to 2007, 168 patients with gastroesophageal variceal bleeding caused by portal hypertension were treated at the People＇s Hospital of Shaanxi Province. Among all the patients, 90 received a splenocaval shunt ＋ PCDV（combined group） and the remaining 78 received PCDV （PCDV group）. Changes in intra- and postoperative hemodynamics of the portal venous system were detected by Doppler color flow imaging, and free portal pressure was measured intraoperatively. All data were analysed using analysis of variance, the paired t test and chi-square test.Results The mortality was 3% （3/90） in the combined group and 5% （4/78） in the PCDV group, with no significant difference between the two groups （Х^2 = 0.038, P 〉0.05 ）. The postoperative rebleeding rate was 6%（5/79） in the combined group, which was significantly lower than 13% （8/60） in the PCDV group （Х^2 =4.824,P 〈 0.05 ）. The incidence of hepatic encephalopathy was 6% （5/79） in the combined group and 7% （4/60） in the PCDV group, with no significant difference between the two groups （ Х^2 = 0.072, P 〉 0.05 ）. The 1-, 3-, 5-,and 10-year survival rates were 97% （77/79）, 92% （55/60）, 80% （16/20） and 60% （3/5） in the combined group, and 97% （58/60）, 83% （40/48）, 73% （22/30） and 53% （8/15） in the PCDV group, respecitvely,with no significant difference between the two groups （ Х^2 = 0.731, P 〉 0.05 ）. The intra- and postoperative portal pressures in the combined group were （38.8±4.2） cm H20 （ 1 cm H2O =0. 098 kPa） and （33.1 ± 1.5） cm H2O,with a significant difference （ t = 8. 574, P 〈 0.05 ）. The intra-and postoperative portal pressures in the PCDV group were （38.9±2.5） cm H2O and （34.6±2.6） cm H2O, with a significant difference （t =6. 530, P 〈0.05

关 键 词：高血压 门静脉 脾腔静脉分流术 外科 血流动力学 断流术 

分 类 号：R657.3[医药卫生—外科学]