贲门周围血管离断术治疗晚期血吸虫病门静脉高压症的近远期疗效  

Short and long-term efficiency of pericardial devascularization for Portal hypertension caused by advanced schistosmiasis

作　　者：邓维成[1] 刘佳新[1] 王鹏[1] 潘舸[1] 

机构地区：[1]湖南省血吸虫病防治所附属湘岳医院血吸虫病免疫与传播控制湖南省重点实验室,湖南岳阳414000

出　　处：《中国现代医学杂志》2012年第5期87-90,共4页China Journal of Modern Medicine

基　　金：湖南省卫生厅重点项目(No:A2007009)

摘　　要：目的评估贲门周围血管离断术(PCDV)治疗晚期血吸虫病门静脉高压症近远期疗效。方法总结1980年1月～2010年1月采用PCDV治疗晚期血吸虫病门静脉高压症患者的资料,统计相关数据,分析近远期疗效。结果治疗性手术493例(急诊手术264例,择期治疗性手术229例),预防性手术1 380例。近期止血率98.1%,手术死亡率1.87%,急诊手术死亡率10.2%,择期治疗性手术死亡率2.6%,预防性手术死亡率0.14%。随访1 629例,总出血率为11.2%,其中治疗性手术后再出血率30.8%,其5、10、20和30年再出血率分别为5.2%、10.1%、1.5%和0.6%。预防性手术后出血率2.3%。5、10、20和30年生存率分别为90.9%、87.6%、80.3%和79.6%,5、10、20和30年肝性脑病发生率分别为1.29%、3.2%、4.5%和4.8%。肝功能好转79.8%,腹水好转87.3%,脾功能亢进症消失81.0%,好转12.3%,食管静脉曲张好转79.8%。结论 PCDV是治疗晚期血吸虫病门静脉高压症的最佳术式;保护已经建立的不碍生命安全的侧支循环,常规联合大网膜包肾术,保留胃冠状静脉的完整性,是保证疗效的关键要点。[Objective] To evaluate the short and long-term efficiency of pericardial devascularization （PCDV） on portal hypertension cases caused by advanced schistosomiasis and to gain the experiences for later clinical treatment. [Methods] The data of PCDV on portal hypertension of advanced schistosomiasis from 1980 to 2010 were collected and analyzed for short and long-term efficiency. [Results] 493 therapeutic oper- ations （264 emergency ones, 229 elective ones）, 1 380 preventive operations were performed. The rate of re- cent hematischesis was 100%. The total death rate among operation was 1.87% in which emergency operative death rate was 10.2%, elective onewas 2.6%, and preventive one was 0.14%. During 1 629 of followed up cases, the total bleeding rate was 11.2%. Re-hemorrhage rate after therapeutic operations was 30.8%. Re- hemorrhage rate was 5.2% in 5 years, 10.1% in 10 years, 1.5% in 20 years and 0.6% in 30 years, respec- tively. Re-hemorrhage rate after preventive operations was 2.3%. Survival rate was 90.9% in5 years, 87.6% in 10 years, 80.3% in 20 years and 79.6% in 30 years, respectively. Incidence of hepatic encephalopathy was 1.29% in 5 years, 3.2% in 10 years, 4.5% in 20 years and 4.8% in 30 years, respectively. 79.8% of liver function were improved, 87.3% of ascites relieved, 81% of hypersplenism disappeared, 12.3% of hypersplenism improved, and 79.8% of esophageal variees relieved. [Conclusion] PCDV is the best selection for PHT of advanced schistosomiasis. Protectingcollateral circulation no impacting body safety, performing omentorenopexy, and retaining the integrity of the coronary vein are the key to ensure treatment effect.

关 键 词：晚期血吸虫病 门静脉高压症 贲门周围血管离断术 疗效 

分 类 号：R532.21[医药卫生—内科学]