选择性贲门周围血管离断术对治疗门静脉高压症的临床价值评估

The therapeutic effect of selective pericardial devascularization on portal hypertention

目的 探讨选择性贲门周围血管离断术对门静脉高压症治疗的价值。方法 自2002 年1月～2004年3月,我院用选择性贲门周围血管离断术共治疗门静脉高压症47例,以104例经典 的贲门周围血管离断术作为对照组。测量病人手术前、切脾后、手术后自由门静脉压力,入院时、手术 后2周的门静脉血流量,观察术后复发出血、肝性脑病、门静脉高压性胃病发生率,腹水、食管胃底静 脉曲张改善程度以及成活情况。结果 选择性贲门周围血管离断术后病人复发性出血、门静脉高压 性胃病发生率明显减低(P<0.05),腹水、食管胃底曲张程度改善(P<0.05),自由门静脉压和门静脉 血流量明显下降(P<0.01),但不增加肝性脑病发生率(P>0.05)。结论 选择性贲门周围血管离断 术保留了机体自发性的分流,兼有分流术和断流术的优点,是一种较合理的手术方式。

Objective To evaluate the curative effect of selective pericardial devascularization on portal hypertention.Methods From January, 2002 to March, 2004, 47 cases of portal hypertension were treated by selective pericardral devascularization and 104 cases by standardized pericardial devascularization. Free portal vein pressure was measured before operation, after splenectomy and after operation. Portal vein blood flow at admission and on 14th day after operation was determined by ultrasonography. The incidence of rebleeding, hepatic encephalopathy, portal hypertensive gastropathy, ameliorative degree of ascites and gastroesophageal variceal and survival time were observed.Results Compared with the controls, the patients undergoing selective pericardial devascularization showed decreased incidence of rebleeding (P< 0.05 ) and portal hypertensive gastropathy (P< 0.05 ), evidently reduced free portal vein pressure (P< 0.01 ), significant improvement of ascites and gastroesophageal variceal (P< 0.05 ), and obviously reduced portal vein blood flows (P< 0.01 ), but the risk of hepatic encephalopathy was not increased (P> 0.05 ).Conclusion Selective pericardial devascularization reserved spontaneous shunts and had virtues of shunt and disconnection, It was a reasonable surgical method.