肝硬化门脉高压食管胃底静脉曲张破裂出血内窥镜治疗失败后再手术时机探讨  

Investigation of the operation time after failure of endoscopic therapy of patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis

作　　者：赫嵘[1] 张珂[1] 李宝亮[1] 黄容海[1] 贾哲[1] 张维[1] 

机构地区：[1]首都医科大学附属北京地坛医院肝胆外科,北京100015

出　　处：《中国肝脏病杂志（电子版）》2014年第3期17-20,共4页Chinese Journal of Liver Diseases：Electronic Version

基　　金：首都临床特色应用研究(Z121107001012169);首都医科大学附属北京地坛医院院内基金项目(QN2011-04)

摘　　要：目的探讨肝硬化门脉高压食管胃底静脉曲张破裂出血内窥镜治疗失败后的再手术时机。方法采用回顾性调查的方法,分析2005年1月至2010年12月48例肝硬化门脉高压症食管胃底静脉曲张破裂出血内窥镜治疗失败后再手术患者病例临床资料,根据术前内窥镜治疗次数分为A组21例,术前内窥镜治疗≤3次;B组27例,术前内窥镜治疗>3次。比较两组病例术中、术后临床指标情况。结果 A组在胃左静脉血栓发生率、手术时间、术中出血量、断流前及断流后门静脉压力、术后并发症发生率、食管胃底静脉曲张复发率明显低于B组,B组行食管下段横断吻合术比例明显低于A组(P均<0.05)。结论肝硬化门脉高压食管胃底静脉曲张破裂出血患者在内窥镜治疗3次失败后,应该及时进行手术治疗。Objective To investigate the operation time after failure of endoscopic therapy of patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis. Methods The clinical data of 48 patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis between 2005 January and 2010 December which receive operation after failure of endoscopic therapy were analyzed retrospectively. According to times of preoperative endoscopic treatment, patients were divided into two groups： group A of 21 cases, which received not more than 3 times of preoperative endoscopic treatment; group B of 27 cases, which received more than three times of preoperative endoscopic treatment. Intraoperative, postoperative clinical indicators were compared between two groups. Results The rate of thrombosis of the left gastric vein, operation time, intraoperative bleeding volume, portal venous pressure of pre-devascularization and post-devascularization, the incidence of postoperative complications, esophagogastric variees recurrence rate of group A was lower than that in group B. Underwent esophageal transection of group B was significantly lower than that of group A （all P 〈 0.05）. Conclusions Patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis should receive opetation after failure of endoscopic therapy not more than three times.

关 键 词：肝硬化 门静脉高压症 食管胃底静脉曲张 内窥镜 手术 

分 类 号：R575.2[医药卫生—消化系统]