联合分流和断流术治疗门静脉高压症180例

Combined splenocaval or mesocaval C shunt plus portoazygous deverscularization for treatment of portal hypertension in 180 cases

目的 探讨联合分流和断流术治疗门静脉高压症的临床效果.方法 对我院1990年5月至2008年5月采用联合分流和断流手术治疗的180例门静脉高压症病人的临床资料进行回顾性分析.结果 术前自由门静脉压力(FPP)为32.5～35.5 cm H2O(1 cm H2O=0.098 kPa);脾切除、脾腔或肠腔分流术后FPP下降为24 cm H2O;联合手术后FPP平均为24.5 cm H2O.全组无手术死亡,125例随访6个月～7年,复发出血4例,肝性脑病4例,人造血管血栓形成4例,肝功能衰竭死亡2例.结论 联合分流和断流术既保留了断流术的优点,又降低了门静脉的压力,是治疗门静脉高压症的理想术式之一.

Objective To explore the therapeutic effect of combined splenocaval or mesocaval C shunt and portoazygous deverscularization for the treatment of portal hypertension. Methods The clinical datas of 180 cases of portal hypertension treated with combined procedures from May 1990 to May 2008 in our hospital were analyzed retrospectively. Results The mean free portal pressure was 32.5 -35.5 cm H2O before operation,24 cm H2O and 24.5 cm H2O after splenectomy plus splenocaval or mesocaval C shunt and combined procedure, respectively. There was no death in all patient,6 months - 7 years follow - up of 125 cases showed that 4 cases with rebleeding,4 cases with encephalopathy,4 cases with thrombosis in artificial vascular graft and 2 cases died of liver failure. Conclusions Combined shunt and portoazygous deverscularization not only decreases portal pressure but preserve hepatic blood flow to some extent, it' s one of the best choices for treating portal hypertension.