贲门及近端胃壁内外双重断流术治疗门静脉高压症出血

Pericardiac and progastric submembranous varix ligation plus pericardiac vascular disconnection for treatment of patients suffering from variceal bleeding

目的探索有效治疗门静脉高压症胃底曲张静脉破裂出血的手术方法。方法采用贲门周围血管离断术（壁外断流）加贲门环周粘膜下血管缝扎和近端胃（胃左动脉平面以上）中点环周缝扎粘膜下血管（壁内断流）。结果本组接受贲门及近端胃壁内外双重断流术４９例，其中单行贲门周围血管离断术（壁外断流）２１例。断流后自由门静脉压分别为（３３±０５）ｍｍＨｇ和（２１０±０１５）ｍｍＨｇ，两者比较Ｐ＜００１；术后随访３月至８年，双断流组无再出血发生，单断流组３例发生再出血，１例出血死亡。结论贲门及近端胃壁内外双重断流术治疗门静脉高压症胃底曲张静脉破裂出血比贲门周围血管离断术更为合理。

Objective To evaluate the effect of pericardiac and progastric submembranous varix ligation plus pericardiac vascular disconnection (double portaarzygous disconnection,DPD) for the treatment of portal hypertensive variceal bleeding.Methods Forty-nine patients underwent DPD procedures.Results were compared with that of 21 control patients receiving traditional pericardiac vascular disconnection.Result The postoperative portal pressure in DPD group was (3 3±0 5) mmHg vs. (2 10±0 15) mmHg in control group ( P <0 01).Patients in both groups were all followed up for 3 months to 8 years with no rebleeding in DPD group and 3 rebleeding cases in control group,with one death from rebleeding.Conclusions DPD procedure is better than traditional pericardiac vascular disconnection in the prevention of postoperative gastroesophageal variceal bleeding.