不同术式治疗门静脉高压症的疗效观察  

Effects of Different Operative Modalities for Portal Hypertension

作　　者：谢树民[1] 杨毅军[1] 韩朝阳[1] 王红军[1] 禹建军[1] 刘洪杰[1] 石景森[2] 

机构地区：[1]河南省焦作市第二人民医院外二科,焦作454100 [2]西安交通大学第一医院肝胆外科,西安710061

出　　处：《中国现代手术学杂志》2002年第2期116-118,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的　评价不同术式治疗门静脉高压症的疗效。　方法　对比 3 8例脾肾分流 (SRS)加贲门周围血管离断术 (PCDV)即联合术 ,64例单纯贲门周围血管离断术 (PCDV) ,18例脾肾分流术 (SRS)病人临床疗效及手术前后门静脉系统血流动力学变化。　结果　术后三组病人的自由门静脉压 (FPP)均显著性低于术前 ,其中 ,联合手术组的FPP显著高于SRS组 ,但显著低于PCDV组。PCDV组术后门静脉血流量 (PVF)与术前相比无显著性差异 ,其余两组则有显著降低。联合手术组、PCDV组、SRS组术后的再出血发生率分别为 2 .63 % (1/ 3 8)、18.75 % (12 / 64 )、16.67% (3 / 18) ,联合手术组显著低于PCDV组 (P <0 .0 5 ) ;肝性脑病发生率分别为 2 .63 % (1/ 3 8)、6.2 5 % (4 / 64 )、2 7.78% (5 / 18) ,联合手术组显著低于SRS组 (P <0 .0 5 ) ,与PCDV组相近。　结论　联合手术符合门静脉高压症手术要求 ,且疗效好于单纯断流术或分流术。Objective To evaluate the effect of different operative modalities for portal hypertension. Methods Thirty eight cases of combined splenorenal shunt and extensive esophagogastric devascularization (combined therapy), sixty four cases of pericardia vascular disconnection (PCDV) and eighteen cases of splenorenal shunt (SRS) were compared prospectively in the clinical effects and portal hemodynamics. Results The free portal pressure (FPP) after the operation of all three groups were significantly lower than that of pre operation, and the FPP of combined therapy group was markedly higher than that of SRS group but lower than that of PCDV group.The portal vein flow (PVF) of PCDV group showed no statistical difference pre and post operatively, and that in the other groups were significantly lowered after the operation, while the combined groups PVF was higher than that in SRS group near the high normal level. When compared with 18.75%(12/64) in PCDV and 16.67%(3/18) in SRS, the rebleeding rate in combined therapy group was 2.63%(1/38). It was significantly lower than that of PCDV group( P <0.05). The hepatic encephalopathy rate of combined therapy group was 2.63%(1/38) that was lower than 27.78%(5/18) in SRS ( P <0.05) and near the PCDVs level. Conclusion The effect of combined therapy for portal hypertention is better than that of single PCDV or SRS.

关 键 词：门静脉高压症 手术方式 脾肾分流术 贲门周围血管离断术 临床疗效 血流动力学 

分 类 号：R657.34[医药卫生—外科学]