对38例门静脉高压症食管曲张静脉破裂大出血治疗的回顾

Therapeutic review in 38 patients with esophageal bleeding varices caused by portal hypertention

讨论１９８２年１月至１９９１年１２月收治的门静脉高压症食管曲张静脉破裂大呕血３８例的治疗．急症手术２１例，术后死亡９例（４２．８％）；择期手术１７例，死亡１例（５．９％）．术式为脾切除、贲门周围血管离断术．全部病例均经病理诊断为肝炎后肝硬变．治疗体会：１．大呕血或内窥镜检查视野不清．可因血液误吸致窒息，主张先行三腔二囊管压迫止血．２．大出血期间及术后病人应常规吸氧．３．非手术治疗４８ｈ无效或止血后短期内再出血者应及早手术．４．护肝期间避免过量补给胶体或全血，以免再出血，择期手术前２ｄ根据情况适量用心得安或镇静剂．５．５０ａ以上病例手术死亡率明显增高（７０．１％）。

cases of portal hypertension bleeding esophageal varices treated with splenectomy + pericardial devascularization from 1982 to 1991 were reported. 29were male and 9 were female. The ageranged from 17～ 76. Of the 38 cases, 17belonged to Child-B, 21 to Child-C. 21 cases underwent emergency and 17 elective operation. There were 9 postoperative deaths in emergency group giving a mortality rate of 42. 8% in comparison with one in elective group, 5. 9%. All pathological diagnosis were posthepatitis cirrhosis.Experiences: 1. Applying the Sengstaken-Blakemore tube first. 2. Oxygen was given during bleeding and postoperative period. 3. After 48 h non-operative therapy,if rebleeding, the patient should be operated immediately. 4. Do not give blood transfusion too much in protecting the liver period in order to avoid rebleeding. 5. The postoperative mortality was high apparently in elder patients (70.1 % ).