断流术治疗门静脉高压症的疗效分析

Portal azygous devascularization for the treatment of patients with portal hypertension

目的 评价断流术治疗门静脉高压症的效果。方法 回顾性分析2 12例门静脉高压症断流术的治疗效果。结果 本组176例(83% )施行Hassab术,36例(17% )施行改良Sugiura术。断流术前后门静脉压力分别为(40±6 )cmH2 O和(36±7)cmH2 O。术后肝功能衰竭发生率为6 % ,其中急诊手术后为2 9 2 % ,择期手术后为3 2 % (P <0 0 1)。手术死亡15例,总手术死亡率为7% ,急诊手术死亡率为33% ,择期手术死亡率为4 % (P <0 0 1)。术后3、5、10年再出血率分别为2 %、6 %、11% ,生存率分别为97%、92 %和89%。结论 断流术止血效果确切,肝功能衰竭和肝性脑病发生率低。急诊手术死亡率高,应尽量避免。断流术引起的门静脉压力下降可能对肝功能造成负面影响。

Objective To evaluate therapeutic effects of portal azygous devascularization on patients with portal hypertension. Methods In this study, data of 212 patients with portal hypertension who underwent devascularization were analyzed retrospectively. Among them 52% patients had a history of variceal bleeding. Preoperative Child A accounted for 15% patients, B for 57% and C for 27%. Emergent operation and selective operation were performed in 11% and 89% cases, respectively. Hassab procedure was performed in 176 cases (83%), whereas modified Sugiura procedure in 36 cases (17%). Results Portal vein pressure decreased from (40±6) cm?H 2O to (36±7) cm?H 2O. The re-bleeding rate of 3, 5,10 years were 2%, 6%, 11%, and the survival rates of 3, 5, 10 years were 97%, 92% and 89%, respectively. Conclusions Devascularization is an effective procedure in controlling bleeding with low incidence of liver failure, operation mortality and encephalopathy. Emergent operation should be avoided as it causes high morbidity and mortality. The decreased portal pressure following devascularization may result in a reduced blood supply to the liver. Persistent exasperation of the liver function caused by chronic hepatitis and the development of hepatocellular carcinoma are the two major factors endangering long-term survival.