急诊门奇断流术治疗门脉高压上消化道大出血12例

Emergent portal-azygous disconnection with splenectomy for portal hypertension with acute massive hemorrhage:a report of 12 cases

目的 总结肝炎后肝硬化门脉高压上消化道大出血行急诊脾切除加门奇断流术的疗效.方法 对我院2000年12月～2005年12月间12例肝炎后肝硬化门脉高压致急性上消化道大出血行急诊脾切除加贲门周围血管离断术进行回顾性分析.结果 本组12例术后上消化道出血均停止.随访2个月～5年,无再出血,肝功能正常或好转,无肝性脑病发生,无死亡.结论 对于部分肝功较差,肝硬化门静脉高压急性上消化道大出血者行急诊门奇断流加脾切除术是安全、有效的治疗方法,止血效果确切,肝功能衰竭和肝性脑病发生率低.

Objective To summarize the efficacy of emergent portal-azygous disconnection with splenectomy for treating hepatocirrhosis,portal hypertension with acute massive hemorrhage due to esophageal varicose vein and varices of fundus of stomach. Methods A retrospective analysis was made on the results of 12 patients with hepatocirrhosis, portal hypertension with acute massive upper digestive tract hemorrhage who were treated with portal-azygous disconnection with splenectomy from Dec. 2000-Dec. 2005 in Chongqing Canser Hospital. Results Upper digestive tract bleeding was controlled by portal-azygous disconnection with splenectomy in all patients. During the follow-up period of 2 months to 5 years. No patients had recurrent bleeding,and their hepatic function was improved or became normal. No case occured hepatic-encephalopathy,no patient died. Conclusion Transabdominal emergent portal-azygous disconnection with splenectomy is one of the effective treatments in emergency for some patients with hepatic inadequacy and acute massive upper digestive tract hemorrhage because of hepatocirrhosis, portal hypertension. Disconnection is an effective procedure in controlling bleeding with low incidence of liver failure,operation mortality and encephalopathy.