门静脉高压症断流术术式的选择

Selection of surgical devascularization in the management of variceal heamorrhage due to portal hypertension

目的研究断流术的不同术式对门静脉高压症(PHT)患者的疗效及预后的影响。方法 PHT患者270例,均经断流术治疗,根据具体术式不同分为单纯脾切除(A组)、选择性联合断流(B组)和选择性贲门周围血管离断(C组),回顾性分析三组疗效。结果与其余两组比较,B组术中自由门静脉压降幅明显,术后ALT水平较低,AST水平较低(P<0.01)。A组住院时间短。术后并发症的发生率及1年内病死率的差异均无统计学意义。结论 PHT患者消化道出血史、中重度食管胃底静脉曲张及内镜下红色征是断流术具体术式选择的决定因素。对以脾功能亢进为主要症状的PHT患者实施单纯脾切除术;存在消化道出血病史、中重度食管胃底静脉曲张和(或)红色征者尽可能行联合断流术。

Objective To investigate the influence of different operation pattens of devascularization for variceal heamorrhage due to portal hypertension（PHT） on the outcomes.Methods The clinical data of 270 patients with PHT underwent devascularization were retrospectively analyzed.The patients were divided into three groups of lienectomy（21 cases,group A）,modified Sugiura operation（199 cases,group B） and extensive devascularization around the cardia（50 cases,group C）.The surgical outcomes were compared.Results Compared to groups of A and C,the patients in group B had a remarkable decrease in free portal pressure with lower postoperative ALT and AST levels.The hospital stay was shorter in group A than that in group B or group C [（24.3±6.8）d vs.（36.3±16.3）d or（36.4±16.0）d]（P0.01）.There were no significant differences in the incidence of early post-operative complications and the 1-year mortality among three groups.Conclusion The key factors for making decition in the management of variceal heamorrhage due to PHT are the history of upper gastrointestinal hemorrhage,moderately severe varicose veins and red-color sign.Lienectomy is performed when hypersplenia due to PHT without varices bleeding.Modified Sugiura operation should be performed in the patients with the history of upper gastrointestinal hemorrhage,moderately severe varicose veins and red-color sign.