选择性远端脾腔静脉分流术治疗门静脉高压症患者断流术后再出血  

Distal splenocaval shunt for rebleeding patients after periesophagastric devascularization

作　　者：周光文[1] 

机构地区：[1]上海交通大学附属第一人民医院普外科,上海200080

出　　处：《中华普通外科杂志》2013年第4期263-265,共3页Chinese Journal of General Surgery

摘　　要：目的探讨选择性远端脾腔静脉分流术治疗门静脉高压症患者断流术后再出血的近期和远期疗效。方法回顾性分析2009年1月至2011年12月18例贲门周围血管离断术后复发食管胃底曲张静脉破裂出血的门静脉高压症患者，术前经Doppler及CT证实脾静脉无血栓，用远端脾静脉一腔静脉直接吻合分流。结果在分流术后，本组18例患者的自由门静脉压从术前的（35．6±3．8）emH20下降至（26．9±2．7）emH20，两者相比差异有统计学意义，t=13．6，P〈0．01。近期手术死亡率为0。术后第2天肝功能较术前发生显著性变化，但术后第7天恢复到术前水平。本组再出血率为17％，腹水发生率为44％，有2例发生肝性脑病，2年生存率为94％。结论远端脾腔静脉分流术是一种较为理想的治疗断流术后再出血的选择性分流术式，但前提是远离脾脏的脾静脉无血栓形成。Objective To evaluate the therapeutic effect of distal splenocaval shunt for portal hypertensive variceal rebleeding after periesophagastrie devaseularization. Method In this study 18 patients with recurrent bleeding after devascularization underwent distal splenoeaval shunt. Clinical data and follow-up resuh were collected and analyzed. Result The free portal pressure decreased from （35.6 ± 3.8 ）em H20 before shunting to （26. 9 ± 2. 7 ） cm H20 after shunting. The operative mortality was 0. Liver function after postoperative second day changed significantly comparing to preoperative levels and it recovered to pre-operative level after 7 days. The rate of rebleeding and ascites was 17% and 44% respectively. There were 2 patients suffering from postshunt hepatic encephalopathy and the 2-year survival rate was 94. 4%. Conclusions Distal splenoeaval shunt could still be performed in portal hypertensive patients with recurrent varieeal bleeding after periesophagastric devascularization with a patent splenic vein.

关 键 词：高血压 门静脉 食管和胃静脉曲张 门腔分流术 外科 手术后出血 

分 类 号：R657.3[医药卫生—外科学]