脾切除贲门周围血管离断术治疗470例门静脉高压症疗效分析

Clinical effects of extensive esophagogastric devascularization and splenectomy on 470 patients with portal hypertension

目的总结脾切除贲门周围血管离断术治疗不合并肝癌及胆管癌的门静脉高压症患者的疗效。方法对不合并肝癌及胆管癌的门静脉高压症患者行脾切除贲门周围血管离断术并随访470例,其中肝炎后肝硬化436例,占92.8%。结果出血患者424例,手术止血率为99.3%(421/424),围手术期病死率为1.4%(6/424),主要死亡原因是上消化道出血、肝肾功能衰竭;急症及择期手术424例,预防手术46例,预防手术围手术期无死亡。平均随访时间4年,出血患者术后复发出血率为3.2%(15/470),预防手术后无出血,肝性脑病发生率为1.9%(9/470)。结论脾切除贲门周围血管离断术防治门静脉高压症引起的上消化道出血效果好。合理选择手术适应证及手术时机、完全彻底断流、术后早期抗凝及近端脾静脉结扎预防术后肝外门静脉系统血栓形成是提高手术疗效的必要措施。

Objective To evaluate the effect of extensive esophagogastric devascularization and splenectomy on portal hypertension without hepatocellular carcinoma or bile duct cancer. Methods Extensive esophagogastric devaseularization and splenectomy were performed and follow-up was made on 470 patients with portal hypertension, of whom 436（92.8%） suffered from cirrhosis due to hepatitis B. Results Bleeding was found in 424 cases, and the bleeding control rate during surgical operation was 99.3% （421/424）. Perioperative mortality rate was 1.4%（6/424）. The major death causes were recurrent upper gastrointestinal hemorrhage and hepatic-renal failure. There were 424 cases receiving emergency operation and selective operation, and 46 cases receiving preventive operation with no deaths during perioperation. The mean follow-up time was 4 years, in which recurrent bleeding rate was 3.2%（15/470）, no rebleeding occurred after preventive operation, and the incidence rate of hepatic encephalopathy was 1.9%（9/470）. Conclusion The esophagogastric devaseularization and splenectomy appear to be effective for the control of varieeal hemorrhage due to portal hypertension. To improve the operation results, the following are necessary measures： the selection of operative opportunity and indications, the thorough porta-azygous disconnection, early anticoagulation therapy postoperatively and the formation of extrahepatic portal vein thrombosis after near splenic vein ligalion.