门静脉高压症术后再出血的外科治疗  

Surgical treatment of postoperative rebleeding in portal hypertension.

作　　者：汪昱[1] 郑起[1] 林擎天[1] 

机构地区：[1]上海市第六人民医院外科,200233

出　　处：《中国实用外科杂志》2001年第3期143-144,共2页Chinese Journal of Practical Surgery

摘　　要：目的　评价外科治疗门静脉高压症术后再出血各种术式的疗效。方法　回顾 30年外科治疗门静脉高压 373例中术后再出血 6 6例临床资料 ,其中首次手术方式分别有单纯脾切除术、门奇静脉断流术、各类非选择性分流术、联合手术 (断流加分流 ) ,术后再出血率分别为 2 6 6 7%、17 86 %、14 5 8%和 4 35 %。再手术组 5 5例中食管下段胃底切除 42例 ,肠系膜上静脉 -下腔静脉分流 (MCS) 11例 ,再断流 2例。非手术组 11例。结果　食管下段胃底切除组手术死亡率 9 5 2 % ( 4/ 42 ) ,随访平均 11年 ,再出血率 9 5 2 % ( 4/ 42 ) ,脑病发生率 14 2 9% ( 6 /42 ) ;再断流组 2例术后 1个月内死亡 ;MCS组 11例无手术死亡 ,随访平均 7 5年 ,无再出血 ,脑病发生率 9 0 9%( 1/ 11) ;非手术组 11例均为门静脉高压性胃病 (PHG)。结论　联合手术能有效减少门静脉高压术后再出血 ,MCS是目前治疗再出血较理想的手术方式。Objective To evaluate the effect of different operative methods for treating rebleeding in patients with portal hypertension(PHT).Methods The clinical data of 66 patients with postoperative rebleeding out of 373 PHT cases during the last 30 years was retrospectively analyzed.Their first operations were splenectomy,portoazygous devascularization,various non selective shunt and combined operation(devascularization combined with shunt),of which,the rebleeding rate were 26\^67%,17\^86%,14\^58% and 4\^35%,respectively.Among 55 cases receiving re operation,there were 42 with distal esophago fundusectomy,11 mesocaval shunt(MCS)and 2 re devascularization.The other 11 cases received nonoperative therapy.Results The mortality,mean follow up time,rebleeding rate and encephalopathy rate were 9\^52%(4/42),11 years,9\^52%(4/42)and 14\^29%(6/42)in distal esophago fundusectomy group;0,7\^5 years,0 and 9\^09%(1/11)in MCS group.All 2 cases in re devascularization group died within one postoperative month.All 11 cases in non operative group were with portal hypertension gastropathy(PHG).Conclusion Combined operation may effectively reduce postoperative rebleeding rate in PHT cases and MCS is a relatively ideal method for treating rebleeding.

关 键 词：门脉高压症 手术后 再出血 分流术 断流术 

分 类 号：R657.34[医药卫生—外科学] R619.1[医药卫生—临床医学]