断流术中保留食管旁静脉的临床效果

A clinical study on devascularization with reservation of paraesophageal vessels in patients with portal hypertension

目的回顾性分析断流术治疗门静脉高压症时,保留自然形成的病理性扩张的食管旁静脉对自由门静脉压(FPP)、肝功能指标变化和术后近期并发症发生率的影响。方法收集我院1994年3月～2006年4月门静脉高压症患者169例,分为单纯脾切除组、保留食管旁静脉组(保留组)和不保留食管旁静脉组(不保留组),比较手术前后FPP变化,并比较断流术组间手术前后肝功能指标变化和术后近期并发症发生率。结果(1)三组手术前后FPP均明显下降(P<0.05),其中保留组下降幅度最大与不保留组比较有显著差异(P<0.01);(2)保留组术后近期并发症发生率明显低于不保留组(P<0.05)。结论保留食管旁静脉的断流术能更有效地降低门静脉压力,并不会使肝功能恶化,且能降低近期并发症发生率。

Objective To investigate the influence of devascularization with reservation of paraesophageal vessels on free portal pressure （FPP）, liver function index and postoperative complications. Methods The clinical data of 169 patients with portal hypertension undervent devascularization were retrospectively analyzed. Ten patients underwent splee nectomy only were assigned into group A, 131 cases received the paraesophageal vessels reservation into group B, and 28 cases operated without reserving the vessels into group C. The changes of FPP, liver function index and postoperative complications were compared between group B and C. Results FPP decreased obviously after devascularization in all three groups（P〈0.05）, which was the most in group B（P〈 0. 01）. There were less postoperative complications in group B than those in group C（P〈0. 05）. Conclusion Devascularization with paraesophageal vessels reservation can decrease FPP more effectively, reduce the postoperative complications, and has slight effect on liver function.