附加限制环的门腔静脉分流加断流和肝动脉强化灌注术治疗门静脉高压症32例疗效分析  

Treatment of 32 portal hypertension with limited portacaval shunt in combination with portoazygous devascularization plus enhancement of perfusion of hepatic artery

作　　者：龚光[1] 赵少勇[1] 朱勇[1] 蒋晓忠[1] 王昌松[1] 黄斌[1] 罗洪[1] 陶友江 

机构地区：[1]四川省宜宾市第二人民医院肝胆胰外科,644000

出　　处：《重庆医学》2011年第10期995-997,共3页Chongqing medicine

基　　金：四川省宜宾市重点科技计划基金资助项目(200803005)

摘　　要：目的探讨附加限制环的门腔静脉分流加断流和肝动脉强化灌注术治疗门静脉高压症的临床疗效。方法 32例肝硬化患者行附加限制环的门腔静脉分流加断流和肝动脉强化灌注术,随访观察围手术期并发症及6、12个月肝功能恢复情况,彩色多普勒显影检测肝血流动力学。结果 32例患者中无围手术期死亡病例。术后腹腔内出血2例(6.2%),胃漏1例(3.1%),腹水12例(37.5%),胸水3例(9.4%)。32例患者中围手术期无肝衰病例,平均住院时间14.5 d。随访12个月,32例患者中无肝性脑病及再发消化道出血病例。术后6个月复查食道钡餐造影,食道静脉曲张明显改善18例,基本消失或消失12例。32例患者手术前彩色多普勒显像对门静脉血流动力学进行观察,门静脉平均直径(14.5±0.8)mm,术后3个月门静脉平均直径(12.2±0.4)mm,平均缩小2.3 mm,其中有3例患者并发门静脉血栓形成。术后6、12个月检测肝纤维化指标较术前明显改善。结论附加限制环的门腔静脉分流加门奇静脉断流和肝动脉强化灌注术不会增加患者的手术负担,能达到治疗因肝硬化引起的胃底食道静脉出血及脾功能亢进的相关并发症,防治及延缓再出血的发生,同时有益于延缓肝纤维化的进展,有益于患者肝功能短期及长期的改善。Objective To investigate clinic treat effect of portal hypertension with limited portacaval shunt in combination with portoazygous devascularization plus enhancement of perfusion of hepatic artery. Methods 32 cases with cirrhosis was performed with limited portacaval shunt in combination with portoazygous devascularization plus enhancement of perfusion of hepatic artery, and was follow-up perioperative complications and recovery of liver function. Results All cases were survived during perioperation, gastric leak case was 1, ascites cases was 12, pleural effusion cases was 3, and without liver failure cases, average hospital stayed was 14.5 day. 12 months was follow-up,no hepatic encephalopathy and gastrointestinal rebleeding cases. After 6 months,32 cases were performed esophageal barium meal examination, esophageal varices significantly improved cases was 18, disappeared and approximate disapeared cases was 12. liver fibrosis index was significantly improved after 6 months and 12 months. Conclusion Limited portacaval shunt in combination with portoazygous devascularization plus enhancement of perfusion of hepatic artery can not only treat bleeding of esophageal-gastric varices,prevention or extension of time of rebleeding,but also be benefit to slow down liver fi brosis progressive and prolong survival time.

关 键 词：门静脉压 分流 断流 肝动脉强化灌注 

分 类 号：R657.3[医药卫生—外科学]