门脉高压症急诊改良Sugiura手术体会

SURGICAL EXPERIENCE OF MODIFIED SUGIURA PROCEDURE IN THE ACUTE UPPER GASTROINTESTINAL HEMATORRHEA CAUSED BY PORTAL HYPERTENTION

目的探讨改良的Sugiura手术在治疗门静脉高压症上消化道大出血中的运用。方法自2001年7月至2007年12月,普外科收治门脉高压症上消化道出血120例,58例急诊行改良的Sugiura手术,47例急诊行贲门周围血管离断术,延期15例行改良的Sugiura手术。结果 105例急性上消化道大出血而急诊手术者术后均立即获得确切的止血效果;改良的Sugiura手术组无吻合口漏及吻合口狭窄发生,术后并发症轻微;贲门周围血管离断组围手术期死亡1例,死于肝功能衰竭;术后两组病人门脉高压性胃病发生程度无明显差异。结论改良的Sugiura手术具有断流彻底、安全性高、再出血少等特点,并未增加手术风险,近期、远期疗效满意,是治疗门静脉高压症上消化道大出血的较佳方法。

Objective To evaluate the effect of modified Sugiura procedure in thetreatment of acute upper gastrointestinal hematorrhea caused by portal hypertention.Methods From July 2001 to December 2007,There were 120 patients suffering from acute upper gastrointestinal hematorrhea caused by portal hypertention secondary to post of hepatitis liver cirrhosis.Among them 105 cases undergoing emergency surgery.We analyzed the results of modified Sugiura procedure performed in 58 patients.Results Bleeding was stopped in all of the 105 cases undergoing emergency surgery with modified Sugiura procedure or traditional extensive esophagogastric devascularization.No anastomotic leakage or stricture was observed in the modified Sugiura procedure group.The post-operative complications were acceptable.Only one patient died of liver function failure post-operation in the traditional group.The hepatic function of the survivals were in stable situation in the followed up.Conclusion The modified Sugiura procedure is satisfactory with a low complication rate,and low bleeding recurrence in the treatment of acute hematorrhea caused by portal hypertention.