小儿门脉高压症脾肾静脉分流术的远期随访及评价

Long-term Results and Evaluation of Spleooreaal Shunt in Children

为了观察小儿门脉高压症脾肾静脉分流术的远期疗效，随访行脾肾静脉分流术后３年以上的患儿２６例。手术时最小年龄５岁。术前有呕血、便血者１９例，其余均有食静脉曲张。肝功能属ＣｈｉｌｄＡ级１３例、Ｂ 级１１例Ｃ级２例。肝内型２０例。１９８０年前１０例均行传统的脾肾静脉分流术，１９８０年后的１６例行改良脾肾静脉分流术为主的联合手术。本组无手术死亡病例。２５例（９６．１％）获访，平均随访９年。死亡６例。通过对１９８０年前后两组对比观察，术后１０年以上生存率及病死率１９８０年后组优于前者（Ｐ＜０．０５）。认为脾肾静脉分流术对控制食管静眯曲张破裂出血有肯定价值，联合手术可提高其疗效。

In order to evaluate the long-term effect and estimate the value of splenorenal shunt in patients with portal hypertension , 26 cases who had accepted the splenorenal shunt for more than 3 years were reviewed. The youngest at operation was 5 years of age. Nineteen patients had hematemesis and melena before operation , the zest had esophageal varices . Their liver function belonged to Child A in 13 , B 11 and C 2. Intrahepatic type was in 20. Traditional splenorenal shunt was performed on 10 cases before 1980 , and combined operation designed by authors was done on 16 after 1980. There was no operative death in this series. Twenty-five patients .96.1% ) were followed-up with an average of 9 years. Ten-year survival duration after l980 were longer than that before 1980 (P< 05) . The authors consider that splenorenal shunt is of a great value in diminishing and controlling the bleeding of esophageal varices and the combined operation may increase the efficacy.