联合术、断流术对门静脉高压术后继发腹腔出血及门静脉血栓形成的影响比较

The comparison of combined splenorenal shunt and portaazygous devascularization on post disconnection of portal hypertension rehaemorrhagia and portal thrombosis

目的比较联合术、断流术对门静脉高压术后继发腹腔出血及门静脉血栓形成的影响。方法将40例食管静脉曲张破裂出血患者随机分为联合术组（20例）和断流术组（20例），分别施行联合术和断流术，对手术前后自由门静脉压（FPP）以及术后腹腔出血情况和门静脉系统血流监测的结果进行比较。结果断流术组与联合术组术后FPP平均降低分别为（4．81±7．26）cmH2O（1cmH2^O=0．098kPa）和（10．04±2．66）cmH2O，两组比较差异有统计学意义（P〈0．05）；腹腔出血及血流动力学不稳定情况：断流术组分别出现5例和6例，而联合术组为0例和2例，两组比较差异有统计学意义（P〈0．01）；门静脉系统血流监测发现：断流术组分别于术后7、14、30d出现门静脉血栓2,4、1例，而联合术组仅于术后7d出现门静脉血栓1例，两组比较差异有统计学意义（P〈0．01）。结论脾肾分流联合门奇断流术不仅能缓解门静脉系统的高压淤血状态，减少术中、术后腹腔出血，而且降低了门静脉血栓形成几率。

Objective To explore the effects of combined splenorenal shunt and portaazygous devascularization on post disconnection of portal hypertension rehaemorrhagia and portal thrombosis.Methotis Forty patients with esophageal variceal bleeding adopted from April 2001 to April 2007 were randomly devided into two groups with different operation procedure： splenorenal shunt combined with portaazygous devascularization （combined shunt group, n = 20） and portaazygous devascularization （simple shunt group, n = 20）. Free portal pressure（FPP） ,postoperative abdominal cavity and portal hemodynamic parameter were investigated and compared. Results Postoperative FPP in combined shunt group was lower than that in simple shunt group （P 〈 0.05 ）. The abdominal cavity bleeding and unsteady hemodynamic parameter was found in 0 patient and 2 patients each in combined shunt group, but was found in 5 patients and 6 patients in simple shunt group. It was significantly lower in combined shunt group than that in simple shunt group （P 〈 0.01 ）. One patient was found portal thrombosis postoperatively in combined shunt group, and 7 patients were found portal thrombosis in simple shunt group. It was significantly lower in combined shunt group than that in simple shunt group （P 〈 0.01 ）. Conclusion The splenorenal shunt operation combined with portaazygous devascularizafion could decrease abdominal cavity bleeding, portal thrombosis and portal hypertension.