保留迷走神经主干门奇断流术对门静脉高压症性胃病影响

The effect of pericardial devascularization with vagustrunk preservation on portal hypertension gastropathy

目的比较保留迷走神经主干门奇断流术(VTPPD)和贲门周围血管离断术(PD)对门静脉高压性胃病(PHG)的影响。方法77例门静脉高压患者分为VTPPD和PD两组,VTPPD组36例,PD组41例,术前和术后第3周常规行胃镜检查,并对两组手术前后PHG的发病率、PHG加重病例比率分别予以比较。结果两组食道胃底静脉曲张皆明显减轻或消失。VTPPD组术前PHG发病率为55.6%(20/36),术后为69.4%(25/36),手术前后发病率差异无统计学意义(P=0.224);PD组术前伴PHG者61.0%(25/41),术后PHG为87.8%(36/41),手术前后差异有统计学意义(P=0.005)。手术后VTP-PD组PHG发病率低于PD组(P=0.048)。PHG程度加重者VTPPD组8例(22.2%,8/36),PD组19例(46.3%,19/41),发生率差异有统计学意义(P=0.027)。结论VTPPD较传统的断流术明显减少PHG的发病率,并可明显减轻加重程度。

Objective： To probe the different influence of perioardial devasoularlzation by preserving vagus trunk（VTPPD） and pericardial devascularization （PD） on portal hypertensive gastropathy （PHG）. Methods ： 77 patients with portal hypertension were divided into VTPPD and PD group,the VTPPD group Included 36 cases,and PD group included 41 cases. Varices of esophagus and fundus of stomach and PHG were observed by gastroscopy before and 3 weeks after operation In all cases, and compared postoperative incidence of PHG in the 2 groups, Resuits ：In all cases,Varices of esophagus and fundus of stomach disappeared or relieved obviously. The Inoidence of PHG In VTPPD group before operation was 55.6%（20/36）,and that after operation was 69.4%（25/36）,the former was not higher statistically（P=0. 224）;the incidence of PHG in PD group before operation was 61. 0%（25/41） ,and that after operation was 87. 8%（36/ 41）,the former was not higher than the latter statistically（P=0.005）;and the postoperative Incidence of PHG in PD group was higher significantly than that in VTPPD group （P=0. 048）. There were 8（22.2%,8/36）patients whose degree of PHG aggravated in VTPPD group,and there were 19（46.3%,19/41）Patients whose degree of PHG aggravated in PD group,the rate of the former was significantly lower than that of the latter（P= 0. 027）. Conclusion：Comparing with the classic portoazygous devascuiarization, VTPPD can reduce the incidence and the degree of PHG.