急诊手术与择期手术治疗门静脉高压症并发上消化道出血的对比研究  

Comparative study on the emergency operation and selective operation in treatment the patients with portal hypertension complicated by upper gastrointestinal bleeding

作　　者：赵威[1] 陈腾[1] 秦建民[1] 陈超[1] 

机构地区：[1]上海市普陀区中心医院普外科,200062

出　　处：《中国医师进修杂志》2014年第14期25-27,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 总结门静脉高压症并发上消化道出血的急诊手术治疗经验,比较急诊手术与择期手术的疗效差异.方法 回顾性分析40例门静脉高压症并发上消化道出血患者的临床资料.按照治疗方法不同分为急诊手术组和择期手术组,每组20例.结果 急诊手术组术中出血量为（313.32±34.17） ml,明显多于择期手术组的（220.13±25.07） ml,急诊手术组肛门排气时间为（1.4±0.7）d,明显长于择期手术组的（0.6±0.2）d,急诊手术组手术时间为（134.32±17.91）min,明显短于择期手术组的（165.71±28.01） min,差异均有统计学意义（P＜0.05）.急诊手术组并发症发生率为20％（4/20）,择期手术组为5％（1/20）,两组比较差异有统计学意义（P＜0.05）.平均随访1.7年,两组病死率比较差异无统计学意义（P＞0.05）.结论 急诊手术治疗门静脉高压症并发上消化道出血是安全有效的治疗方法,止血效果确切,手术时机的把握和围手术期处理是急诊手术成功的关键.Objective To study the treatment experience on emergency operation in patients with portal hypertension complicated by upper gastrointestinal bleeding,and compare the difference between emergency operation and selective operation.Methods The data of 40 patients with portal hypertension complicated with upper gastrointestinal bleeding were retrospectively analyzed.The patients were divided into emergency operation group and selective operation group according to the treatment method with 20 cases each.Results The intraoperative bleeding in emergency operation group was significantly more than that in selective operation group [（313.32 ± 34.17） ml vs.（220.13 ± 25.07） ml],the time of passage of gas by anus in emergency operation group was significantly longer than that in selective operation group [（1.4 ± 0.7） d vs.（0.6 ± 0.2） d],the operation time in emergency operation group was significantly shorter than that in selective operation group [（134.32 ± 17.91） min vs.（165.71 ± 28.01） min],there were statistical differences （P 〈 0.05）.The rate of complication in emergency operation group was 20% （4/20）,in selective operation group was 5%（1/20）,there was statistical difference （P〈 0.05）.The mean follow up time was 1.7 years,there was no statistical difference in fatality rate between the 2 groups （P 〉 0.05）.Conclusions Emergency operation for portal hypertension complicated by upper gastrointestinal bleeding is a safe and effective method of treatment,and the effectiveness of hemostasis is exact.The timing of operation grasp and perioperative management are the key to successful emergency operation.

关 键 词：高血压 门静脉 上消化道出血 急诊手术 

分 类 号：R657.4[医药卫生—外科学]