术中门静脉压力决定手术方式的评价(附112例病例分析)

Determination of surgical approaches by portal pressure during operation: an analysis of 112 cases

目的分析了门静脉高压症术中门静脉压力与术后再出血的关系,探讨在规范实施断流术的前提下,何时应加做分流手术。方法回顾性调查了1996～1999年间我院外科门静脉高压症断流术的病例112例。选择肝功能分级、断流前后门静脉压力、再出血的程度(黑便/呕血)作为指标进行观察。结果(1)开腹后,门静脉压力<35cmH2O的例数为29例,>35cmH2O的为83例;断流后,门静脉压力<35cmH2O的例数为39例,>35cmH2O的为73例。(2)肝功能分级A、B级术后再出血率明显低于肝功能C级的病例,且后者的再出血的发生时间明显短于前者,程度多以呕血为主。(3)断流前门静脉压力低于与高于35cmH2O的病例,术后再出血的发生率、再出血发生时间及程度没有明显差别。(4)断流后门静脉压力>35cmH2O的病例术后再出血率明显高于压力<35cmH2O的病例,且再出血的发生时间明显缩短,出血的程度亦加重。结论断流术后测定的门静脉压力的数值与术后再出血在发生率、发生时间以及程度上均有关系,如果断流术后门静脉压力仍>35cmH2O,应该加做分流手术,即采用分断流联合手术。

Objective To investigate the relationship between perioperative portal pressure and postoperative re-bleeding in patients with portal hypertension to determine when shunt should be done under the condition of performing devascularization. Methods The clinical data of 112 patients with portal hypertension receiving devascularization in our hospital from 1996 to 1999 were retrospectively analyzed. The Child classification, pre-and postoperative portal pressure and degree of postoperative re-bleeding were chosen as the major parameters for the study. Results 1) The portal pressure was below 35 cmH_2O in 29 cases and 39 but over 35 cmH_2O in 83 and 83 before and after the devascularization, respectively. 2) The occurring rate of postoperative re-bleeding was lower in the patients with liver function of Child A and B than in those with that of Child C. 3) There were no significant differences in occurring rate, appearing time and severity of postoperative re-bleeding between the patients with a portal pressure below 35 cmH_2O and those with that over 35 cmH_2O before the operation. 4) The occurring rate of postoperative re-bleeding was markedly higher in the patients with a portal pressure over 35 cmH_2O than in those with that below 35 cmH_2O after the devascularization. Conclusions The post-devascularization portal pressure is related to occurring rate, appearing time and severity of postoperative re-bleeding. The shunt should be performed in the patients with a post-devascularization portal pressure over 35 cmH_2O.