门静脉高压症断流术后并发症的防治  

The prevention and treatment of postoperative complications after portaazygous disconnection in patients with portal hypertension

作　　者：徐均耀[1] 杨镇[1] 王雄彪[1] 李海洋[1] 孙政[1] 马永彪[1] 裘法祖[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科,武汉430030

出　　处：《中华普通外科杂志》2004年第3期133-135,共3页Chinese Journal of General Surgery

摘　　要：目的总结采用断流术治疗门静脉高压症的经验 ,分析术后并发症的发生原因并探讨其防治要点。方法自 1994年 4月～ 2 0 0 2年 7月我院为 2 36例肝硬化门静脉高压症患者施行了断流术 ,对这些病例进行回顾性分析。结果本组 6 5例术后发生并发症 (发生率为 2 7 5 % ) ,包括术后感染 2 4例 (10 2 % )、腹腔内出血 12例 (5 1% )、近期复发上消化道出血 8例 (3 4 % )、大量腹水 12例(5 1% )、急性门静脉血栓形成 7例 (3 0 % )、多器官功能不全综合征 2例 (1 0 % )。住院期间死亡8例 (死亡率为 3 4 % )。主要死亡原因 :腹腔内大出血致失血性休克 (2例 )、肝功能衰竭 (2例 )、重度感染全身衰竭 (4例 )。结论断流术后是否发生并发症主要取决于 :(1)手术适应证和手术时机的把握 ;(2 )手术技巧的掌握 ,术中应做到完全彻底的门奇静脉断流 ;(3)积极有效的围手术期处理。Objective To review our experiences in portaazygous disconnection for the treatment of portal hypertension and to analyze the causes of postoperative complications. Methods We reviewed the results of 236 patients with portal hypertension who were treated with disconnection from April 1994 to July 2002. Results Postoperative complications occurred in 65 of all the patients(the incidence rate was 27.5%). Twenty-four patients experienced postoperative infection(10.2%),12 patients suffered from intraabdominal massive bleeding(5.1%),12 from massive ascites (5.1%),8 patients suffered from recurrent upper gastrointestinal bleeding (3.4%),7 patients experienced acute thrombosis of portal venous system(3.0%). Two patients suffered from multiple organ dysfunction syndrome (1.0%). The operative mortality was 3.4%(8/236). The main causes of death included intraabdominal massive bleeding and severe infection with MODS. Conclusions The occurrence of postoperative complications was related with the selection of patients,thorough portaazygous disconnection and perioperative management.

关 键 词：门静脉高压症 断流术 术后并发症 预防 治疗 原因 

分 类 号：R657.3[医药卫生—外科学]