门静脉高压症断流手术方式及其疗效的探讨  

PROCEDURE AND EFFECT OF DEVASCULARIZATION FOR PROTAL HYPERTENSION

作　　者：张劲光[1] 徐光勋[1] 郭庆良[1] 武聚山[1] 郭文斌[2] 吴健雄[3] 钱智玲[1] 

机构地区：[1]首都医科大学北京佑安医院腹部外科,北京100054 [2]大连市中心医院腹部外科,大连116033 [3]中国医学科学院肿瘤医院腹部外科,北京100021

出　　处：《肝胆外科杂志》2003年第2期101-102,共2页Journal of Hepatobiliary Surgery

摘　　要：目的　评价门静脉高压症断流手术方式及其疗效。方法　对 1996年 1月～ 2 0 0 2年 1月我科收治的 167例门静脉高压症接受断流手术治疗的患者进行随访 ,其中肝功能 Child A级 4 6例、B级 115例和 C级 6例。结果　本组无手术死亡和近期再出血。术后发生并发症 3 7例 ,占 2 2 %。其中术后胃出血 19例 ,9例需手术止血。随访 13 2例 ,平均随访 3 2个月。术后行钡餐和胃镜检查 ,断流手术后再发静脉曲张的发生率为 2 0 % (2 6/ 13 2 )。其中接受单纯贲门周围血管离断术的 5 0例 ,有 2 2例表现为中重度曲张 ;贲门周围血管离断 +食管横断术 5 6例中仅有 4例表现为轻度静脉曲张 ;食管下段 +胃近端切除者 2 6例均无再发静脉曲张。结论　断流手术采用单纯贲门周围血管离断术者效果较差 ,而接受食管下段 +胃近端切除术的患者均未再发静脉曲张 。Objective To improve the procedure and effect of devascularization for patients with protal hypertension.Methods The data about the procedure and effect of devascularization in 167 patients in our hospital within the last 6 years were evaluated and reviewed.Results There was no mortality and short term rebleeding;37 patients had postoperative complications(37/167)including postoperative gastric bleeding in 19 cases.132 patients received barium meal examination and gastroscopy on follow-up of an average of 32 months.26 of 132 patients were found to develope new esophageal varices.Among them,22 patients with moderate-severe varicaes who underwent simple pericardial devascularization; 4 Patients with slight varices who underwent pericardial devaseularization plus esophagus transection and manastomosis.None of the 26 patients receiving lower part esophagus resection plus proximal gastrectomy developed recurrent esophageal varices.Conclusion The result of simple pericardial devascularization was unsatisfactory.Lower part esophagus resection plus proximal gastrectomy had good short and long term result for the treatment of upper gastronintestinal rebleeding due to portal hypertension.

关 键 词：高压症 门静脉 食管和胃静脉曲张 断流手术 胃切除 

分 类 号：R657.34[医药卫生—外科学]