门奇断流术与联合手术治疗食道静脉破裂出血的比较研究  

Comparative study of portaazygous devascularization and combined operation in the treatment of esophageal variceal bleeding

作　　者：熊炳贤[1] 谢敏[1] 孙晋友[1] 李红浪[1] 沈威[1] 

机构地区：[1]江西医学院第二附属医院普外科,江西南昌330006

出　　处：《中国普通外科杂志》2002年第1期10-12,共3页China Journal of General Surgery

摘　　要：目的　 比较门奇断流术和联合术 (门奇断流术加脾肾分流术 )治疗食道静脉破裂出血 (EVB)的效果。 方法　 将 1995年 10月～ 2 0 0 0年 10月入院的 2 8例EVB患者随机分为两组 ,分别施行联合术 ( 14例 )和断流术 ( 14例 ) ,通过术中测自由门静脉压 (FPP )和手术前后测量门静脉血流量 (PVF)、术后食道吞钡摄片及疗效观察进行比较。结果　断流术与联合术后FPP平均降低分别为 ( 4 .81± 7.2 6 )cmH2 O和 ( 10 .0 3± 2 .6 6 )cmH2 O ,联合组手术前后比较和两组术式比较均有显著意义 (均P <0 .0 5 ) ;PVF :断流术后平均增加 ( 92± 6 4)ml/min ,联合术后平均降低 ( 130± 82 )ml/min ,两组间比较有显著差异 (P <0 .0 5 ) ,联合术组前后比较差异亦有显著性 (均P <0 .0 5 )。联合术组近期出血率 ,肝性脑病发生率及远期出血率、食道静脉曲张和临床疗效均好于断流术组。 结论　 联合术既保留了断流术和分流术二者的优点 ,又克服了二者的缺点 ,具有止血效果确切 ,作用持久 ,再出血率、肝性脑病发生率及病死率低等优点 。Objective To compare of the effect of portaazygous devascularization(PADV) and combination operation(splenorenal shunt plus portaazygous devascularization)on the treatment of esophageal variceal bleeding(EVB).Methods 28 cases of EVB admitted from October 1995 to October 2000 were divided randomly into two groups:(1)PADV group (14 cases);(2) combination operation(14 patients).The free portal pressure(FPP) and portal veinous flow(PVF)were measured intraoperatively; and pre and post-operative barium meal and therapeutic effect between 2 groups were compared.Results The average value of FPP of PADV group and combination operation group reduced (4.81±7.26)cmH 2O and (10.03±2.66)cmH 2O respectively after operation, there were significant difference (both P<0.05) compared to preopative value. The average value of PVF increased[(92±64) ml/min]after PADV(P<0.05) and siguificantly decreased [(130±82) ml/min]after combination operation (P<0.05).After operation, the rebleeding rate in short-term and long-term, the hepatic encephalopathy occurrence rate, the improvement rate of esophageal variceal and clincal effect on combined operation were better than those in PADV group. Conclusions The combined proceduer has merits on stopping hemorrhage with lower rates of recurrent bleeding,hepatic encepalopathy and mortality. Combined operation is a rational and practical procedure for patients with EVB.

关 键 词：食管和胃静脉曲张 胃肠出血 门奇静脉断流术 脾肾分流术 对比研究 外科手术 

分 类 号：R571.305[医药卫生—消化系统]