保脾断流术治疗门静脉高压症上消化道出血的疗效分析  

Analysis on Therapeutic Effect of Selective Paraesophagogastric Devascularization Without Splenectomy for Treatment of Portal Hypertension with Upper Gastrointestinal Hemorrhage

作　　者：王东[1] 栗光明[1] 朱继业[1] 胡志平[1] 冷希圣[1] 

机构地区：[1]北京大学人民医院肝胆外科,北京100044

出　　处：《中国普外基础与临床杂志》2013年第1期29-32,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：卫生行业科研专项资金资助(项目编号:201002015)~~

摘　　要：目的探讨保留脾脏的选择性贲门周围血管离断术治疗门静脉高压症上消化道出血的疗效。方法笔者所在医院2008～2011年期间共实施保脾断流术治疗门静脉高压症上消化道出血患者27例,观察其保脾断流手术前后血象、肝功能、并发症、自由门静脉压力(FPP)等指标,术后对患者进行长期随访,观察再出血率和生存情况。结果保脾断流术后FPP下降了12.4%(P<0.05);术后总体并发症发生率为33.3%(9/27),其中包括2例(7.4%)应激性溃疡出血,1例(3.7%)门静脉高压性胃病出血,1例(3.7%)下肢深静脉血栓,1例(3.7%)急性肺损伤,1例(3.7%)肝性脑病于术后第8天死亡,3例(11.1%)新发门静脉血栓。24例患者获随访,随访时间为8～57个月,平均27个月,存活率为92.6%(25/27)。结论保留脾脏的选择性贲门周围血管离断术是治疗门静脉高压症上消化道出血的一种有效术式。Objective To evaluate the therapeutic effect of selective paraesophagogastric devascularization without splenectomy in treatment of portal hypertension with upper gastrointestinal hemorrhage.Methods The clinical data of 27 patients who received selective paraesophagogastric devascularization without splenectomy from 2008 to 2011 were retrospectively analyzed.The hemogram,hepatic function,perioperative compliations,and free portal pressure（FPP） were observed.The patients were followed-up and the re-bleeding rate and survival rate were observed.Results The FPP decreased significantly （P0.05） after operation.The complication rate was 33.3% （9/27） after operation,including 2 cases （7.4%） stress ulcer bleeding,1 case（3.7%） acute bleeding portal hypertensive gastropathy,1 case（3.7%） deep venous thrombosis,1 case（3.7%） acute lung injury,1 case（3.7%） death of hepatic encephalopathy,3 cases（11.1%） new onset portal vein thrombosis.Twenty-four patients were followed up for an average of 27 months（8-57 months）.The overal survival rate was 92.6%（25/27）.Conclusion Selective paraesophagogastric devascularization without splenectomy is an effective method for treatment of portal hypertension with upper gastrointestinal hemorrhage.

关 键 词：门静脉高压症 选择性贲门周围血管离断术 脾脏 

分 类 号：R657.34[医药卫生—外科学]