胆道多次手术合并肝硬化门静脉高压症的评估及处理

Assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension

目的探讨胆道多次手术同时合并肝硬化门静脉高压症的评估及处理。方法回顾性分析2005年1月至2008年12月我院收治的18例胆道多次手术同时合并肝硬化门静脉高压症患者的临床资料。结果 18例胆道多次手术同时合并肝硬化门静脉高压症患者中,按照Child-Pugh分级,A级4例,B级10例,C级4例。肝硬化原因:胆汁性肝硬化14例(77.8%),肝炎后肝硬化2例,血吸虫性肝硬化2例。单独行胆道多次手术16例,联合行胆道多次手术和断流术2例;术中出血量达800～1600 mL。术后并发症:胆瘘1例,肠瘘1例,上消化道出血1例;1例在围手术期死于肝功能失代偿,多脏器功能衰竭。结论对胆道多次手术同时合并肝硬化门静脉高压症的患者,尽管手术有较大的风险,只要加强术前相关问题的评估,制定合理治疗措施,手术可以取得良好的效果。肝功能Child-Pugh分级标准不适合再次胆道合并肝硬化门静脉高压症患者的评估要求。

Objective To probe the assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension.Methods The clinical data of 18 patients of bile duct re-operation accompanied with hepatocirrhosis and portal hypertension from January 2005 to December 2008 were retrospectively analyzed.Results Of the 18 patients,4 were grouped to Child A according to Child-Pugh classification,10 were child B,another 4 were Child C.As to the causes of hepatocirrhosis： 14 patients（77.8%） resulted from biliary cirrhosis,2 posthepatitic cirrhosis,2 schistosomiasis cirrhosis.Sixteen patients received simply biliary tract re-operation,2 received biliary tract re-operation with devascularization;the bleeding amount during operation was up to 800～1 600 mL.Three of whom had post-operative complications： 1 with biliary fistula,1 with intestinal fistula and 1 with upper gastrointestinal bleeding.The other patient died of multi-organ dysfunction in preoperative period.Conclusion To the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension,surgical operation will get good results if the assessment of relevant pre-operative issues are enhanced and the appropriate treatments are executed.Child-Pugh classification is not appropriate to assess the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension.