肝硬化门静脉高压症的外科治疗分析

Clinical experience in the surgical management of cirrhotic portal hypertention

目的 总结外科治疗肝硬化门静脉高压症的经验。方法 回顾性分析 1 995年 1月至2 0 0 0年 1 2月因肝硬化门静脉高压症食管胃底静脉曲张行外科手术的 96例患者。结果 本组手术死亡 (术后 30d内 )的 8例患者中有 6例肝功能为ChildC级。手术死亡率在急诊分流术组为 33%(4 1. 2 ) ,急诊断流术组为 1 1 %(1 . 9)。累计死亡率与肝功能分级显著相关 (P <0 . 0 1 ) ,与术式选择无相关 (P >0 . 0 5 )。累计术后再出血率分流术组为 5 %(3 5. 6 ) ,断流术组为 1 0 %(4 4. 0 )。结论 决定患者长期生存的最重要因素是患者的肝功能储备而非手术方式。肝功能较差患者的急诊手术应选择断流术。拖延手术 (出血至手术时间 >2 4h)是急诊手术死亡率高的主要原因。外科手术预防和治疗食管胃底静脉曲张出血的效果都是满意的。

Objective To review our experience in the surgical management of portal hypertention of cirrhotic etiology. Methods A series of 96 portal hypertensive cases undergoing surgical management from Jan 1995 to Dec 2000 was analyzed. Results Six out of 8 perioperative deaths were of Childs C grade; The perioperative mortality rate was 33% (4/12) in emergent shunt group and 11% (1/9) in emergent devascularization group respectively. The cumulative mortality was not related to the surgical modality but to the patient′s liver function classification. The cumulative postoperative rebleeding rate was 5% (3/56) and 10% ( 4/40) in shunt group and devascularization group respectively. Conclusion The single most important factor in determining long term survival was not the surgical modality but the liver function reserve.Devascularization was better than shunt in emergent surgical management especially in Child C patients; Delayed surgery (bleeding to operative time>24 h) was the main cause of high emergent perioperative death rate. There was a rationale for prophylactic surgery.