门静脉高压症并胃静脉曲张断流术中自发性胃肾分流道的保护及其意义  

Protection of the spontaneous gastro-renal shunt during devascularization for gastric varices of portal hypertension

作　　者：田明国[1] 杨勇[1] 贾东 刘明奇 辛国军[1] TIAN Ming-guo;YANG Yong;JIA Dong;LIU Ming-qi;XIN Guo-jun(Department of Hepatobiliary Surgery, the People’s Hospital of NingXia Autonomous Region, Yinchuan 750002, China)

机构地区：[1]宁夏自治区人民医院肝胆外科,宁夏银川750002

出　　处：《肝胆胰外科杂志》2019年第1期34-37,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：宁夏回族自治区重大研发计划项目(宁科计字2017-33)

摘　　要：目的探讨门静脉高压症并胃静脉曲张及自发性胃肾分流道时选择性断流的手术方法及其临床疗效。方法对手术前门静脉CT检查发现有胃静脉曲张伴自发性胃肾分流道的患者,在脾切除术后离断结扎胃静脉曲张的输入血管,保留自发性胃肾分流道。纵行离断肝胃韧带。不对食管下段及胃底贲门进行游离。观察门静脉压力变化、手术时间、手术出血量、术后胃肠功能恢复情况、门静脉血栓发生率、胃静脉曲张消失率以及复发出血率。结果本组共31例,手术时间(221±128)min,手术出血量(326±228)mL,术中门静脉自由压力为切脾前(35.5±17.52)cmH_2O、切脾后(26.5±21.35)cmH_2O、断流后(28.3±22.61)cmH_2O。术后平均胃管拔除时间(2.8±1.5)d,无胃瘫及肝性脑病发生,术后随访时间22个月(6～48个月),无复发出血,胃静脉曲张消失26例(83.87%)、明显缩小5例(16.13%),CT显示原胃肾分流道通畅,发生门静脉血栓3例(9.68%)。结论保护自发性胃肾分流道的选择性断流术可有效降低胃食道静脉曲张的压力,达到防治出血的目的;同时不影响来自肠系膜上、下静脉血流进入肝脏代谢,达到选择性分流术的效果。不游离食管下段及胃底贲门可简化手术操作,降低手术并发症。Objective To explore a new selective devascularization for portal hypertensive gastric varices with spontaneous gastrorenal shunt. Methods For the patients with gastric varices and spontaneous gastrorenal shunt by preoperative CT evaluation, the affluent vessels of the varices were ligated with preservation of the spontaneous gastrorenal shunt following splenectomy. The hepatogastric ligment was divided longitudinally and the lower part of the esophagus, gastric fundus and the cardias were not isolated. The portal pressure, operation time, operative bleeding, postoperative recovery of gastroenteral function, portal venous thrombosis, elimination rate of gastric varices and recurrence of hemmorrage were recorded. Results This procedure had been successfully done in 31 patients with operation time (221±128) min and operative bleeding (326±228) mL. The mean FPP was (35.5±17.52) cmH 2 O,(26.5±21.35) cmH 2 O and (28.3±22.61) cmH 2 O before and after splenectomy and after devascularization. The average time of nasogastric tube removal was (2.8±1.5) d. There was no occurrence of gastric paralysis and hepatic encephalopathy. During follow-up of 22 months (6~48) months, there was no recurrence of bleeding. The gastric varices disappeared in 26 cases (83.87%) and remarkably reduced in size in 5 cases (16.13%). All the original spontaneous gatric-renal shunts were patent by CT scanning. Portal venous thrombosis occurred in 3 cases (9.68%). Conclusion Preservation of SGRS in selective devascularization can reduce the pressure of the gastroesophageal varices effectively and can reach the aim of prevention and hemostaisis without influence on the hepatic blood inflow from both the superiorand inferior mesenteric veins, and therefore obtain the result of selective shunt. Without dissection of the lower esophagus, gastric fundus and cardia can simplify operation and reduce the surgical complications.

关 键 词：高血压 门静脉 胃静脉曲张 自发性胃肾分流道 选择性断流术 

分 类 号：R657.34[医药卫生—外科学]