改良Walker′s术治疗门静脉高压症术后再出血的体会

Modified transthoracic esophageal transection (modified Walker’s procedure) for management of postoperative recurrent bleeding of portal hypertension:26 year's experience

目的回顾评价改良的经胸食管横断术(改良Walker's术)方式治疗门静脉高压症术后再出血的效果。方法根据Sugiura术的血液动力学原理,将经胸食管横断术进行改良(改良Walker's术),在食管下段较低位置阻断食管静脉血流的同时,离断腹段残留或复发的冠状静脉属支。结果本组共52例,择期手术48例,无手术死亡;急症手术4例,1例死于肝功能衰竭。本组中5例失访,有45例获得长期随访,结果在术后1年5个月因肝功能衰竭死亡1例,术后2～3年2例死于肝癌;术后4～5年3例因肝功能衰竭、肝肾综合症死亡;存活5年以上者有39例,5年生存率75%(9/52)。有1例患者已经再手术后生存23年。结论改良Walker's术适用于门静脉高压症术后再出血患者,该手术简单易掌握、止血可靠,近期、远期效果良好。

Objective To review our experience and evaluate the efficacy of modified transthoracic esophageal transection（modified Walker＇s procedure） for the management of postoperative recurrent bleeding in patients with portal hypertension.Methods According to the hemodynamic principles of Sugiura＇s operation,we have adopted since 1983 modified Walker＇s operation to make low esophageal transaction and transect the intraabdominal recurrent varix of the coronary vein in the treatment of recurrent bleeding of portal hypertension.Results In 52 cases of postoperative rebleeding of portal hypertension,48 were treated by selective operation without postoperative mortality,whereas 4 received emergency operation with 1 died postoperatively due to hepatic failure.The postoperative control rate of recurrent bleeding was 100%,and the overall postoperative mortality was 1.9%（1/52）.The longest postoperative survival time was 23 years,and the 5-year survival rate was 75%.There were no postoperative recurrent hemorrhage and hepatic encephalopathy.Conclusions Modified transthoracic esophageal transection（modified Walker＇s operation） is a rational operative method for postoperative recurrent bleeding of portal hypertension.It is a method easy to perform,with a reliable immediate hemostatic effect and long-term control of variceal hemorrhage.