门静脉高压症行断流术后再出血43例诊治体会  

Mechanism and experience in treatment of rebleeding after devascularization for portal hypertension:A report of 43 cases

作　　者：王文静[1] 曹国军[1] 胡青钢[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,湖北武汉430022

出　　处：《中国实用外科杂志》2015年第12期1321-1324,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨门静脉高压症断流术后上消化道再出血的原因及机制，总结临床诊治经验。方法回顾性分析华中科技大学同济医学院附属协和医院肝胆外科自2012年7月至2014年12月收治因门静脉高压症行断流术后再出血43例病人临床资料。结果急诊手术2例，1例因胃底瘤样曲张静脉破裂出血，行胃底静脉瘤捆扎止血；另1例为弥漫性胃底贲门瘤样曲张静脉破裂出血行近端胃切除术，术后第8天死亡。择期手术10例，8例复发重度食管胃底静脉曲张行再次断流术，2例为胃底静脉瘤样曲张行近端胃切除术。15例局限性静脉曲张行内镜下治疗。其余均保守治疗。35例病人获得随访，随访时间0．5～2．5年，无一例复发出血。结论对于门静脉高压症行断流术后再出血，应根据病因和病情，采取个体化的治疗方案。Objective To explore the causes and mechanism of upper gastrointestinal （GI） rebleeding after pericardia devascularization in portal hypertension （PHT） in order to enhance the diagnostic level and therapeutic effects. Methods The clinical data of 43 cases of rebleeding after devascularization for portal hypertension admitted from July 2012 to December 2014 in Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. Results Of the 2 cases by emergent operation, 1 case caused by aneurysmaf variceal bleeding of gastric fundus was treated by strapping of aneurysmal varicosity; 1 case of diffusivity cardia-fudus aneurysmal varicosity who was treated by proximal gastrectomy died on 8th days after surgery. Of 10 cases by selective operation, 8 cases caused by recurrence of severe esophageal and gastric varices were treated by second devascularization; 2 cases of fudus aneurysmal varicosity was treated by proximal gastrectomy. A total of 15 cases of localized varicosity were treated by endoscopic therapy. The rest cases were cured by conservative treatments. No rebleeding occurred in the period of 0.5 to 2.5 years of following up in 35 cases. Conclusion For rebleeding after pericardial devascularization, individualized treatment can gain satisfactory effects.

关 键 词：门静脉高压症 断流术 再出血 消化道出血 

分 类 号：R6[医药卫生—外科学]