选择性贲门周围血管离断术治疗门静脉高压症的临床价值  

The Therapeutic Effect of Selective Pericardial Devascularization On Portal Hypertension

作　　者：蒋春晖[1] 吴志勇[1] 徐庆[1] 顾磊[1] 刘晔[1] 孙隆慈[1] 罗蒙[1] 周鸿[1] 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,上海200127

出　　处：《现代生物医学进展》2015年第35期6915-6918,6968,共5页Progress in Modern Biomedicine

摘　　要：目的:探讨选择性断流术与传统断流术在门静脉高压症手术治疗中的疗效。方法:分析我院从2007年10月至2013年10月行传统断流术52例患者与行选择性断流术的34例患者的临床资料,对两组进行回顾性对比分析。结果:选择性断流术术后近期脾窝积液、发热以及随访期间再出血、门静脉高压性胃病(portal hypertensive gastropathy,PHG)发生率明显减低(P<0.05),食管胃底静脉曲张程度明显减轻(P<0.05),肝性脑病发生率未增加(P>0.05)。结论:选择性断流术可以明显改善断流术后再出血和PHG发病率高的问题,降低术后并发症的发生,近期疗效显著。但术后6-12月,食管旁静脉均基本闭塞,远期疗效还有待于进一步研究。Objective： To evaluate comparatively the therapeutic effects of selective and non-selective devascularization procedures in the surgical treatment of portal hypertension. Methods： A total of 86 patients with portal hypertension admitted to our hospital from October 2007 to October 2013 were divided into two groups nonrandomly, 34 cases were given selective devascularization（observation group） and 52 cases were treated with pericardial devascularization （control group）. The Follow-up results of the clinical data were retrospectively analyzed. Results： No significant difference of free portal pressure （FPP） was shown between the two groups before and after splenectomy. The FPP was 23.58± 1.55 mmHg in the control group, 21.65± 2.18 mmHg in the observation group after the operation. Compared with the control group, the patients undergoing selective devascularization showed that fluid in splenic fossa, febrile, rebleeding and portal hypertensive gastropathy were decreased （P〈0.05） and the degree of gastroesophageal variceal was improved（P〈0. 05）, while the risk of hepatic encephalopathy showed no increase（P〉0.05）. Conclusions： The short-term effect of selective devascularization is significant, because of the low request of liver function which can preserve spontaneous shunts of the body and hence effectively attenuate early term complications of portal hypertension. But after six-twelve months, paraesophageal vein were fundamentally occluded, the long-term effect needs further study.

关 键 词：选择性断流 门静脉高压症 自由门静脉压 手术方式 

分 类 号：R657.34[医药卫生—外科学] R615[医药卫生—临床医学]