门奇断流加大网膜覆盖后腹膜术108例临床分析

Clinical analysis of 108 cases on the porta-azygus devascularization plus great omentopesy in the retroperitoneum

目的 探讨门奇断流加大网膜覆盖后腹膜术治疗门静脉高压症出血的临床疗效。方法 对1994年8月～2001年12月施行此术式的108例门静脉高压症出血的病例进行回顾性分析。结果 术后死亡3例,死亡率2.78％,3例均属Child肝功能C级,均为急症手术,3例死因分别为急性胃粘膜糜烂出血、肝肾综合征、腹腔感染并中毒性休克。其余105例术后无再出血,未出现肝性脑病,术后肝功能均有不同程序恢复,术后1个月～1年复查钡餐或胃镜示食道胃底静脉曲张完全消失者84例、未消失但均有不同程度减轻者21例。结论 此术式断流兼有术后自发性分流作用。术后止血效果确切,Hb、PTL恢复快,术后并发症少。且此术式经腹进行、手术操作简单、手术范围不大、对肝功能要求不甚高,适于基层医院推广。

Objective To investigate the porta-azygous devascularization plus great omentum covered to retroperitoneum in the treatment of clinical efficacy of bleeding of portal hypertension. Methods From August 1994 to December 2001, 108 cases of bleeding of portal hypertension performed this operation were analyzed retrospec-tively. Results 3 cases was death postoperatively. The mortality rate was 2. 78%. 3 cases belonged to child' s degree C and died from acute erosive hemorrhagic gastritis, hepato-renal syndrome, abdominal infection associated with toxic shock respectively. In the other 105 cases, no rebleeding and no hepatic encephalopathy were found after operation. Postoperative liver functions were recovered in different degree. In the postoperative 1 month to 1 year, Barium meal or gastroscopy showed which fundic-esophageal varices were disappeared in 84 cases, but there were relief of different degree in 21 cases. Conclusion This devascularization accompany with a role of spontaneous bypass. Postoperative hemostatic effect is confirmed. Postoperative complications is very low. If the operation is performed via abdomen, this operative technique is simple, operative field is smaller and liver function demanded is not so high. So, it is worthy to use in the basie hospital.