区域性断流术的临床应用  

Clinical application of regional devascularization

作　　者：过欣来[1] 黄金鑫[1] 杨永康[1] 周主青[1] 尤天庚[1] 赵中辛[1] 

机构地区：[1]同济大学附属东方医院普通外科,上海200120

出　　处：《腹部外科》2016年第3期179-182,208,共5页Journal of Abdominal Surgery

基　　金：上海市科委自然科学基金(16ZR1428200)

摘　　要：目的 进行区域性断流术40例病人和同期经典贲门周围血管离断术68例病人的资料对比分析,初步评价区域性断流术的疗效.方法 对108例手术病人于断流前、后测定自由门静脉压力（free portal pressure,FPP）,进行组内及组间比较.随访1～4年,术后动态比较观察病人的肝功能变化（术前1d、术后第3天、第7天、第14天）,腹水感染、肝性脑病发生率,1年再出血率、死亡率.结果 区域性断流术组FPP下降幅度与经典贲门周围血管离断术差异无统计学意义（P＞0.05）.区域性断流组病人肝功能1周左右恢复到术前水平;经典贲门周围血管离断术组2周时恢复到术前水平.区域性断流术组平均住院时间为（23.4±6.8）d,术中平均出血量为200 ml,腹水感染率为10.0％,术后1年再出血率为2.5％、死亡率为5.0％;经典贲门周围血管离断术组,平均住院时间为（26.3±16.3）d,术中平均出血量为400 ml,腹水感染率为11.8％,术后1年再出血率为8.8％、死亡率为7.3％.结论 区域性断流术创伤小,术后1年再出血率为5％,近期疗效满意,是治疗门静脉高压症合并上消化道大出血的有效手段之一,特别适合肝功能评分高分值Child-PughB级（Child-Pugh 分级分值11分以上,肝功能检查前白蛋白低于100 mg/L）以及急诊手术的病人.Objective A retrospective analysis was made on the results of 40 cases of portal hy- pertension treated with regional devascularization and those of 68 patients with perioesophagogastric devascularization from Jan. 2006 to Dec. 2011 in Shanghai East Hospital. The main observation inde- xes were liver function, ascites infection rate, the rate of re-bleeding and fatality, and the merits and demerits of regional devascularization were then preliminarily assessed. Methods Free portal pressure （FPP） was evaluated by intro-group and intergroup comparison. The liver {unction （1 day before and 3, 7, 14 days after surgery）, ascites infection rate, hepatic encephalopathy rate, re-bleeding rate, and mortality rate were observed. Results The decreased amplitude of FPP in the regional devascularizafion group was less than that in the periesophagogastric devascularization group, but there was no significant difference. The liver function in the regional devascularization group retumed to the baseline one week latex after surgery and exceeded the preoperative level two weeks later, and it took two weeks to return to the baseline in the periesophagogastric devascularization group. In the regional devascularization group the aver- age hospital stay was 23.4 ± 6. 8 days, the average intra-operative bleeding was 200 mL, the ascites infection rate was 10. 0%, the re-hleeding rate within 1 year was 2. 5%,and fatality rate within I year was 5. 0%,and in the periesophagogastric devascularizafion group, the average hospital stay was 26. 3 ± 16. 3 days, the aver- age intra-operative bleeding was 400 mL, the ascites infection rate was 11.8%, the re-bleeding rate within 1 year was 8. 8%, and the fatality rate within 1 year was 7. 3%. Condusions Regional devascularization with less damage is effective to treat upper gastrointestinal bleeding caused by portal hypertension, especially to the patients of Child B-C and emergency ones.

关 键 词：肝硬化 门静脉高压 区域性断流术 

分 类 号：R657.34[医药卫生—外科学] R657.31[医药卫生—临床医学]