门静脉高压断流术后再出血的临床分析  

Clinical Analysis for the Recurrent Upper Gastrointestinal Bleeding in Portal Hypertension Patients after Pericardial Devascularization

作　　者：李小琴[1] 菅志远[1] 赵艳梅[1] 朱晓晨[1] 陈晓凤[1] 吴杰[1] 

机构地区：[1]湖北省十堰市太和医院(湖北医药学院附属医院)肝胆胰外科诊疗中心,十堰442000

出　　处：《中国现代手术学杂志》2015年第4期255-258,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的分析门静脉高压症行断流术后再出血的诊断治疗方式。方法对16例行断流手术后再出血的门静脉高压症患者的临床资料进行回顾性分析。16例患者中,1例拒绝内镜和手术治疗,余15例行内镜检查,发现2例存在门脉高压性溃疡,采用药物治疗,5例患者采用了内镜下套扎止血,2例患者采用了改良的Sugiura再次断流手术,7例采用了限制性门腔分流术。结果拒绝内镜和手术治疗的1例患者因出血无法控制死亡,内镜套扎组2例患者因再次出血接受了第2次内镜套扎,其中1例再次出血死亡,断流的2例患者中有1例出现食管下端瘘经肠内营养治疗治愈,分流术的7例患者中有1例发生间断性肝性脑病。结论对门静脉高压症断流术后再出血的病人首先需要明确病因,对肝功能较差者可采用内镜套扎治疗,肝功能较好者可采用限制性门腔分流,再次采用断流手术需要慎重。Objective To analyze the diagnosis and treatment of the recurrent upper gastrointestinal bleeding in portal hypertension patients after pericardial devascularization. Methods The clinical data of16 patients suffered from the portal hypertension and recurrent upper gastrointestinal bleeding after pericardial devascularization was analyzed retrospectively. 1 patient refused the endoscopic therapy and re-operation and the other 15 patients received the endoscopy. 1 patient only received the drug therapy for the re-bleeding caused by the portal hypertension ulcer. And in the 14 patients caused by varicose veins,5 received the endoscopic loop ligature,2 patients received the modified Sugiura devascularization procedure,and the other 7 patients received the limited portal-caval shunt. Results 1 patient died because the bleeding could not control by nonoperation measures. 2 patients received the second time endoscopic loop ligature because of recurrent bleeding and 1 patient died because of the re-bleeding. 1 patient complicated esophageal fistula and healed by enteral nutrition through a naso-intestinal tube in the modified Sugiura procedure group. And 1 patient complicated the hepatic encephalopathy in the portal-caval shunt group and was controlled by drugs. Conclusions For the patients suffered from recurrent upper gastrointestinal bleeding after pericardial devascularization,the re-bleeding causes should be confirmed firstly,and the endoscopic loop ligature should be used in the liver insufficiency patient,and the limited portal-caval shunt procedure is a good choice for the patients with Child-Paugh A grade of liver function,while the second time devascularization procedure should be used cautiously.

关 键 词：高血压 门静脉 出血 脾切除术 断流术 分流术 

分 类 号：R657.34[医药卫生—外科学]