直线切割器在联合断流术中的应用及疗效分析  

Application and curative effect of linear stapler in combined devascularization for ruptured esophagogastric varices bleeding

作　　者：胡国华[1] 顾大镛[1] 吴国豪[1] 

机构地区：[1]复旦大学附属中山医院普外科复旦大学普通外科研究所,上海200032

出　　处：《腹部外科》2012年第4期203-205,共3页Journal of Abdominal Surgery

摘　　要：目的探讨直线切割器在联合断流术中应用的效果。方法收集2001年1月至2010年12月10年间收治的421例有出血史的门静脉高压症病人的临床资料，将其分为使用直线切割器的联合断流术组360例和贲门周围血管离断术组61例，回顾性分析比较两种术式的围手术期、近期检查和远期随访的结果。结果两种术式在手术时间、住院天数、并发症发生率和手术死亡率上差异无统计学意义，但前者的输血量少于后者。两种术式在改善食管静脉曲张程度上差异无统计学意义，但后者对肝功能的损害比前者轻。相比贲门周围血管离断术，联合断流术能够降低术后再出血率，同时没有增加肝性脑病发生率和死亡率。结论联合断流术是治疗门静脉高压症食管静脉曲张破裂出血的主要术式，使用直线切割器不仅没有增加手术风险，而且能有效降低术后再出血率。Objective To investigate the curative effects of linear stapler in combined devascularization for ruptured esophagogastric varices bleeding in last 10 years. Methods The clinical data of 421 cases of portal hypertension （PHT） who underwent devascularization procedures between Jan. 2001 and Dee. 2010 were collected, and the patients were divided into combined devascularization with linear stapler group and pericardial devascularization group. The outcomes of peri-operative period, short-term examination and long-term follow-up were retrospectively analyzed. Results The average operative time, hospital stay, post-operative complication rate and mortality in combined devascularization with linear stapler group were similar to those in pericardial devascularization group, but the blood transfusion volume in the former was less than in the latter. There was no significant diEerence in relieving the degree of esophagogastric varices between two groups, but hepatic dysfunction in the latter was milder. As compared with pericardial devascularization group, combined devascularization with linear stapler group had lower post-operative recurrent bleeding rate, but simultaneously didn＇t increase the incidence of hepatic encephalopathy and long-term mortality. Conclusion Combined devascularization has become the major procedure in the surgical treatment of ruptured esophagogastric varices bleeding caused by PHT. Linear stapler not only doesn＇t increase the surgical risk, but also reduces the post-operative re-bleeding incidence effectively.

关 键 词：高血压 门静脉 食管和胃静脉曲张 

分 类 号：R657.34[医药卫生—外科学]