贲门周围血管离断术治疗门静脉高压症的疗效分析  

The effect of pericardial devascularization on portal hypertension

作　　者：杨镇[1] 刘飞龙[1] 戴植本[1] 裘法祖[1] 

机构地区：[1]同济医科大学附属同济医院外科,430030

出　　处：《中华普通外科杂志》1998年第2期74-76,共3页Chinese Journal of General Surgery

摘　　要：目的总结贲门周围血管离断术治疗门静脉高压症合并上消化道大出血的疗效。方法自1972年5月～1996年10月行贲门周围血管离断术431例,其中肝炎后肝硬变254例,血吸虫病性肝硬变106例。结果急诊手术止血率94.9%,手术总死亡率5.1%,主要死亡原因是上消化道出血、腹腔内大出血和肝肾功能衰竭。平均随访时间为3.8年,5年生存率为94.1%、10年生存率为70.7%,术后复发出血率为6.2%(5年)和13.3%(10年),肝性脑病发生率为2.5%(5年)和4.1%(10年)。结论该手术疗效满意,为提高疗效应做到:(1)断流彻底。(2)熟练掌握本术式的技术要点。(3)合理掌握手术适应证和手术时机。To evaluate the effect of pericardial devascularization on upper GI bleeding due to portal hy- pertension.Methods From May 1972 to October 1996,431 portal hypertensive patients were treated using pericardial devascularization.Among them,245 cases were of portal hypertensive cirrhotics,106 cases were of hepatic schistosomiasis.Results The bleeding control rate of emergency operation was 94.9%.Overall opera- tive morbidity rate was 5.1%.The major death causes were recurrent upper GI bleeding,intraabdominal hemor- rhage,hepatic-renal failure.The mean follow-up time was 3.8 years.Actuarial survival rate was 94.1% at 5 years,and 70.7% at 10 years.Recurrent bleeding rate was 6.2% at 5 years,and 13.3% at 10 years.The hep- atic encephalopathy rate was 2.5% at 5 years,and 4.1% at 10 years.Conclusion The pericardial devascu- larization appears to be effective for the control of variceal hemorrhage due to portal hypertension.In order to improve the result,we should like to emphasize(1)the importance of whole and thorough porta-azygous discon- nection,(2)performing the operation in according to the corrective technique,(3)selecting the operative can- didates and timing rationally.

关 键 词：贲门周围血管离断术 疗效 门静脉高血压 

分 类 号：R657.34[医药卫生—外科学]