肝硬化食管胃底静脉曲张患者内镜治疗后再出血行Hassab手术的有效性和安全性  

The efficacy and safety of Hassab operation for recurrent hemorrhage after endoscopic treatment in patients with liver cirrhosis and esophageal and gastric varices

作　　者：熊企秋 贾哲 蒋力 Xiong Qiqiu;Jia Zhe;Jiang Li(Department of General Surgery,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院普外科,北京100015

出　　处：《中国医学前沿杂志(电子版)》2025年第2期28-33,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的 探讨脾切除联合贲门周围血管离断术(Hassab手术)在内镜治疗后再出血的肝硬化食管胃底静脉曲张患者中应用的有效性及安全性。方法 回顾性收集首都医科大学附属北京地坛医院在2016年9月至2019年9月期间接受Hassab手术治疗的163例乙型肝炎肝硬化伴食管胃底静脉曲张患者的临床资料,依据既往是否接受内镜下治疗分为观察组(82例,曾接受内镜治疗)与对照组(81例,未接受内镜治疗),比较两组术前、术中、术后各项指标之间的差异。结果 观察组患者在术后住院天数、腹腔感染、胰瘘、出血、门静脉压力、再出血、终末期肝病模型(Model for End-Stage Liver Disease,MELD)评分等方面与对照组相比,差异无统计学意义(P>0.05)。观察组患者手术时间长于对照组(Z=-3.44,P<0.001)、术中出血量多于对照组(Z=-2.62,P=0.009)。两组患者术后门静脉压力均分别低于术前门静脉压力(观察组Z=-7.22,P<0.001;对照组Z=-6.37,P<0.001)。术后1年时两组患者MELD评分均较术前MELD评分降低(观察组:Z=-5.33,P<0.001;对照组Z=-4.61,P<0.001)。结论 内镜治疗后再出血的肝硬化食管胃底静脉曲张患者行Hassab手术,具备良好的安全性和有效性。Objective To evaluate the effectiveness and safety of the Hassab operation in treating recurrent hemorrhage in patients with liver cirrhosis and esophageal and gastric varices previously managed by endoscopy.Methods We retrospectively collected clinical data from 163 patients with liver cirrhosis and esophageal and gastric varices treated by endoscopy at Beijing Ditan Hospital,Capital Medical University,between September 2016 and September 2019.The patients were divided into two groups based on whether they had received prior endoscopic treatment:the observation group(n=82)and the control group(n=81)and the differences of various indexes between the two groups before,during and after surgery were compared.Results No significant differences were found between the observation and control groups in terms of postoperative hospital duration,peritoneal infection,pancreatic fistula,bleeding,portal vein pressure,recurrent hemorrhage,and Model for End-Stage Liver Disease(MELD)score.However,the operation time in the observation group was significantly longer than in the control group(Z=-3.44,P<0.001),and intraoperative bleeding volume was greater in the observed group(Z=-2.62,P=0.009).Both groups exhibited a statistically significant decrease in portal vein pressure compared to preoperative values(observed group:Z=-7.22,P<0.001;control group:Z=-6.37,P<0.001),with statistically significant differences.Additionally,one year post-surgery,the MELD score decreased significantly from preoperative levels in both groups,and the difference was statistically significant(observation group:Z=-5.33,P<0.001;control group:Z=-4.61,P<0.001).Conclusions The Hassab operation is effective and safe for treating recurrent hemorrhage in patients with liver cirrhosis and esophageal and gastric varices previously treated by endoscopy.

关 键 词：HASSAB手术 脾切除术 门静脉高压 内镜治疗 

分 类 号：R57[医药卫生—消化系统]