食管胃底吻合联合贲门周围血管离断术治疗门静脉高压症上消化道出血的疗效分析  

Esophagofundostomy combined with pericardial devascularization for the treatment of esophagogastric variceal bleeding

作　　者：王智勇[1] 孟兴凯[1] 王万祥[1] 任建军[1] 王茂春 陈一博[1] 张俊晶[1,2] Wang Zhiyong;Meng Xingkai;Wang Wanxiang;Ren Jianjun;Wang Maochun;Chen Yibo;Zhang Junjingu(department of Hepatobiliary Surgery,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;department of General Surgery,the First Hospital of Hohhot,Hohhot 010030,China)

机构地区：[1]内蒙古医科大学附属医院肝胆外科,呼和浩特010050 [2]呼和浩特市第一医院普通外科,010030

出　　处：《中华普通外科杂志》2021年第5期355-359,共5页Chinese Journal of General Surgery

基　　金：内蒙古自然科学基金重大项目[2015ZD(LH)01];内蒙古自治区草原英才培养专项基金(CYYC2012040);内蒙古医科大学青年创新基金(YKD2017QNCX041)。

摘　　要：目的:探讨食管胃底吻合联合贲门周围血管离断术治疗门静脉高压症上消化道出血的临床疗效。方法:回顾性分析2009年2月至2015年2月内蒙古医科大学附属医院收治的108例门静脉高压症上消化道出血患者的临床资料,其中行食管胃底吻合联合贲门周围血管离断术(研究组)42例,单纯行贲门周围血管离断术组(对照组)66例。两组患者均有脾大或脾功能亢进,术中常规切除脾脏。结果:研究组和对照组手术时间比较差异有统计学意义[(157±41)min比(143±27)min,t=2.81,P<0.05]。研究组术后6个月食管胃底静脉曲张改善情况明显优于对照组,差异有统计学意义(Z=2.47,P<0.05)。研究组术后1、3、5年再出血率分别为2%、5%、10%,对照组术后1、3、5年再出血率分别为15%、21%、26%,差异均有统计学意义(χ^(2)=5.49、4.27、4.31,均P<0.05)。结论:食管胃底吻合联合贲门周围血管离断术断流更彻底、再出血率低,在治疗门静脉高压症上消化道出血中具有一定的价值。Objective To investigate the clinical effect of esophagofundostomy combined with pericardial devascularization in the treatment of upper gastrointestinal hemorrhage caused by portal hypertension.Methods The clinical data of 108 patients with portal hypertension admitted to the Affiliated Hospital of Inner Mongolia Medical University from Feb 2009 to Feb 2015 were analyzed.Among them 42 patients underwent esophagofundostomy combined with pericardial devascularization as the study group,and 66 patients underwent pericardial devascularization only as the control group.All patients presented with splenomegaly or hypersplenism;the spleen was routinely removed during the operation.Results The difference of operation time between the study group and the control group was statistically significant[(157±41)min vs.(143±27)min,t=2.81,P<0.05].The improvement in the esophagogastric varices in the study group within 6 months was significantly better than that in the control group(Z=2.47,P<0.05).In addition,the rebleeding rates of varicose veins within 1,3 and 5 years in the study group was 2%,5%and 10%,while that in the control group was 15%,21%and 26%(χ^(2)=5.49,4.27,4.31,all P<0.05).Conclusions Esophagofundostomy combined with pericardia devascularization achieves complete devascularization and low rebleeding rate.

关 键 词：高血压 门静脉 食管和胃静脉曲张 胃肠道出血 吻合术 外科 贲门周围血管离断术 

分 类 号：R657.3[医药卫生—外科学]