选择性贲门周围血管离断和经腹食管下段横断吻合术治疗门脉高压症食管静脉曲张出血的临床研究

The clinical study of selective paraesophagogastric devascularization and splenectomy plus distal esophageal transection and reanastomosis with stapler for treatment of esophageal variceal bleeding due to portal hypertension

目的:探讨选择性贲门周围血管离断经腹食管下段横断吻合术治疗门脉高压症食管静脉曲张破裂出血(EVB)的效果。方法:回顾性分析2002年7月～2006年1月18例肝硬化门脉高压症EVB患者行选择性贲门周围血管离断和吻合器经腹食管下段横断吻合术的临床资料,分析其疗效。结果:18例患者随访时间3～42月。无1例发生术后死亡、吻合口漏和肝性脑病。1例(5.6%)出现吻合口狭窄,3个月后缓解。至今无1例再出血。11例(61.1%)上消化道造影或胃镜检查显示食道下段、胃底静脉曲张消失,7例有轻度的食管静脉曲张;12例术前有门脉高压性胃病的患者术后明显改善。结论:选择性贲门周围血管离断和吻合器食道下段横断吻合术能有效地治疗门脉高压症食管静脉曲张破裂出血,降低术后再出血率和并发症发生率。

Objective：To investigate the effect of selective esophagogastric devascularization and splenectomy plus transection and reanastomosis of distal esophagus with a circular stapler on esophageal variceal bleeding due to portal hypertension. Methods：A retrospective analysis was made on the results of 18 patients with liver cirrhosis, portal hypertension, esophageal and gastric variceal bleeding who were treated with selective esophagogastric devascularization plus transection and reanastomosis of the distal esophagus with esophagus stapler in our department. Results：All the patients were followed up from 3 to 42 months. There was no operative mortality, no esophageal anastomotic leakage and no encephalopathy after operation. The rebleeding rate was 0%. Anastomotic stenosis took place in one case during the early postoperative period （5.6%） and meliorated after 3 months of operation. The varicose veins in 11 patients （61.1%） were eliminated after operation. Seven cases had slight varicose veins. The portal hypertensive gastropathy in 12 cases was improved significantly after operation. Conclusion：In treatment of esophageal and gastric variceal bleeding due to portal hypertension, the effect of selective esophagogastric devascularization plus transection and reanastomosis of distal esophagus with esophagus stapler is a satisfactory method with a low rehleeding and complication rate.