吻合器在治疗门静脉高压症术中的应用

Application of anastomat in the surgery of portal hypertension

目的探讨经腹应用吻合器食管下段部分切除加贲门周围血管离断术治疗门静脉高压症的疗效。方法将84例门静脉高压症的患者，分成经腹应用吻合器食管下段部分切除加贲门周围血管离断术（切除组142例和单纯贲门周围血管离断术（单纯组）42例。对照两组的疗效和安全性进行比较。结果切除组中无再出血，术后3个月42例病人经上消化道造影或胃镜检查证实食管下段曲张静脉均消失，食管曲张静脉治愈率为100％，未出现吻合口狭窄。单纯组中再出血率26．2％（11／42），术后3个月有21例曲张静脉消失，治愈率为50％；术后12个月复查有25例出现中、重度曲张静脉，占59．5％。结论应用吻合器食管下段部分切除吻合术是安全的，可使离断更彻底，降低复发，从而进一步提高周围血管离断术的疗效.

Objective To investigate the therapeutice effect of the partial resection of lower part of the esophagus plus perieardial pevascularization by using transabdominal anastomat in the treatment of portal hyportension. Methods In 84 portal hypertensive patients, 42 were that were treated with partial resection of lower part of the esophagus with transabdominal anastomat plus pericardial devascularization （as experimental group） and 42 were that were treated with only pericardial derivascularization （as control group）. The therapeutic effect and security were evaluated. Results In the experimental group, no patients had rebleeding, the varicose veins of lower part of the esophagus disappeared after 3 months, the cure rate of varicose veins was 100%, the stenosis rate of anastomotic stoma was zero; In the control group, the rebleeding rate was 26.2% （11/42）, the cure rate of varicose veins was 50% after 3 months, 25 patients were checked to have moderate or severe varicose veins after 12 months. Conclusion Partial resection of lower part of the esophagus in the treatment of portal hyportension is safe. It could improve the effect of pericardial devascularization and lower the recrudescence rate.