排钉阻断法贲门周围血管断流术治疗门静脉高压症52例

Therapeutic effects of linear stapler pericardial devascularization on portal hypertension:analysis of 52 cases

目的:介绍一种自行设计的简便易行且能有效治疗门静脉高压症的手术方式——"排钉阻断法贲门周围血管断流术",并进行初步评价。方法:就1998年11月至今所施行的"排钉阻断法贲门周围血管断流术"治疗门静脉高压症52例,对其临床资料进行分析总结。结果:52例均属病毒性肝炎肝硬化,肝功能Child分级为A级9例(17%),B级31例(62%),C级12例(21%)。其中急诊手术6例,预防性手术8例,其余均为择期手术。手术过程均顺利,无手术死亡,术后均恢复良好。6例急症手术病人均于术后立即止血,无近期再出血,无肝性脑病发生。随访51例,随访期为术后1个月至术后9年3个月;3例术后出血,再出血率5.77%;4例死亡(术前肝功分级均为ChildC级)。其余47例术后6个月复查肝功能,较术前改善者40例(85.1%),无变化者7例(14.9%)。术后1年内复查食管钡餐检查,35例食管静脉曲张明显好转,11例曲张静脉消失,1例无变化。病人术后劳动能力和生活质量较术前普遍提高。结论:排钉阻断法贲门周围血管断流术治疗门静脉高压症简便易行,疗效满意,值得进一步研究及临床推广。

Objectives To introduce a self-designed method, the linear stapler pericardial devaseularization in treating portal hypertension, and to evaluate the therapeutic effects. Methods The clinical data from 52 patients with portal hypertension undergoing linear stapler pericardial devascularization fi＇om Nov 1998 to May 2008 were analyzed retrospectively. Results All the patients had liver cin＇hosis due to viral hepatitis; 9 patients belonged to Child＇s classification degree A, 31 to degree B, and 12 to degree C. Emergency operation was performed in 6 cases, 8 cases were submitted to prophylactic surgery., and the rest to selective operation. The operations were performed smoothly, without operative mortality. The hemorrhage in 6 patients was controlled by emergency operation. The postoperative recovery of patients was uneventful with no cases of bleeding and hepatic encephalopathy. The follow-up data of 51 patients from 1 month to 9 year and 3 months postoperatively showed that bleeding oecured in 3 patients （5.77%）. The liver function of 4 cases that died belonged to Child＇s degree C preoperatively. Forty patients （85.1%） experienced improvement in their liver function within 6 months after the operation, while 7 had no change. The esophageal variees were extenuated in 35 cases, vanished in 11, and remained unchanged in 1 patient. The physical capacity and quality of life were improved in all the patients. Conclusions Tbe ＂linear stapler pericardial devascularization＂ is a convenient and effective procedure for the treatment of portal hypertension. It deserves further study in order to be popularized in clinical practice.