门静脉高压症上消化道出血行急诊断流术的治疗体会  

Experience on Emergency Devascularization for Treatment of Upper Gastrointestinal Bleeding due to Portal Hypertension

作　　者：许永庆[1] 戴朝六[1] 卜献民[1] 彭松林[1] 徐锋[1] 贾昌俊[1] 赵阳[1] 赵闯[1] 赵亮[1] 

机构地区：[1]中国医科大学附属盛京医院肝胆脾外科,辽宁沈阳110004

出　　处：《中国普外基础与临床杂志》2013年第1期33-36,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨并总结急诊断流术对门静脉高压症并发上消化道大出血的治疗效果与经验。方法回顾性分析2006年3月至2011年7月期间中国医科大学附属盛京医院急诊行断流术治疗的42例门静脉高压症并发上消化道大出血患者的临床资料。结果 29例急诊行脾切除+贲门周围血管离断术,8例急诊行脾动脉结扎+贲门周围血管离断术,5例急诊行单纯贲门周围血管离断术。术后3 h内手术止血率为100%,1例于术后第8天因肝功能衰竭死亡,3例术后2 d内出现腹腔渗血,经保守治疗后渗血停止。其余患者术后经2～4周治疗后均顺利出院。术后1年常规随访,5例失访,36例获访患者中1例于术后8个月再次出血,经胃镜套扎成功止血;1例于术后7个月体检发现原发性肝癌,行肝部分切除术;其余患者可以进行一般的日常工作和生活。结论对于门静脉高压症并发上消化道大出血者,把握恰当的手术时机,果断实施急诊断流术,可以迅速而有效止血,挽救患者的生命。Objective To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension.Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension,undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed.Results Of the 42 cases,29 patients underwent emergency splenectomy plus esophagogastric devascularization,8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization,and 5 patients only underwent emergency esophagogastric devascularization.The hemostasis rate at 3 hours after emergent disconnection operation was 100%.One patient died of liver failure on 8 days after operation.Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation,and succeeded in hemostasis by conservative treatment.Other patients were successfully discharged from hospital after postoperative rehabilitation for 2-4 weeks.All cases were followed up regular in 1 year after operation,5 patients were lost to follow-up.Among the 36 cases followed up,rehaemorrhagia occurred in 1 patient in 8 months after operation,cured by endoscopic variceal ligation subsequently.A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation,followed by partial hepatectomy.Other patients could complete daily life and work.Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations.Decisive emergency devascularization can stop the bleeding rapidly and effectively,and save the lives of those patients.

关 键 词：门静脉高压症 静脉曲张出血 急诊手术 断流术 脾切除术 

分 类 号：R657.34[医药卫生—外科学]