肠腔分流并选择性血管缝扎术治疗成人门静脉海绵样变性疗效观察  

Efficaay observation of mesocaval shunt combined with selective vascular ligation for portal hy-pertension caused by cavernous transformation of the portal vein in adults

作　　者：陈刚[1] 许冰[1] 郭国校[1] 

机构地区：[1]郑州大学第一附属医院肝胆胰外科,450052

出　　处：《中国实用医刊》2012年第10期63-64,共2页Chinese Journal of Practical Medicine

摘　　要：目的探讨肠腔分流并选择性冠状血管缝扎术对成人门静脉海绵样变性的治疗作用及临床价值。方法对郑州大学第一附属医院收治的28例成人门静脉海绵样变性并行肠腔分流、脾动脉结扎、选择性冠状静脉缝扎术治疗患者的临床资料结合国内外资料进行回顾性分析。采用SPSS17．0统计软件对数据进行分析，两样本均数的比较采用t检验。结果本组无手术死亡病例，分流后自由门静脉压力平均下降9．8cmH2O（1cmH2O=0．098kPa），术后并发轻微肝性脑病2例，乳糜漏3例，应激性溃疡出血1例，均通过非手术治疗后痊愈。26例得到随访，血氨正常，人工血管均通畅。2例再发出血，1例行脾切断流术，1例行改良脾肺固定术。结论肠腔分流并选择性血管缝扎术对成人门静脉海绵样变性是安全有效合理的手术方式。Objective To investigate the clinical effect of mesocaval shunt combined with se- lective vascular ligation for portal hypertension caused by cavernous transformation of the portal vein in adults. Methods The clinical data of 28 adult patients with portal hypertension caused by cavernous transformation of the portal vein treated by mesocaval shunt plus splenic artery combined with coronary vein ligation were retrospectively analyzed. SPSS17.0 statistical software was used for data analysis, two sample t test was used for comparing. Results There was no operative death case, free portal pressure after shunt decreased 9.8 cm H20（ 1 cm H20 =0. 098 kPa） , postoperative complications included slight hepatic encephalopathy in 2 cases, chylous leakage in 3 cases, stress ulcer bleeding in 1 case,which were cured by conservative treatment. Twenty-six cases were followed up, normal blood ammonia, artifi- cial blood vessels were unobstructed. Rebleeding in 2 cases, 1 case was performed with splenopneumo- pexy, 1 case was performed with splenectomy plus pericardial devascularization. Conclusions Mesoca- val shunt combined with selective vascular ligation for portal hypertension caused by cavernous transfor- mation of the portal vein in adults is a safe and effective operative method.

关 键 词：门静脉海绵样变性 肠腔分流术 缝扎术 外科治疗 

分 类 号：R657.3[医药卫生—外科学]