急症门-奇静脉断流加脾切除术30例报告

Porto-azygous vein disconnection plus splenectomy in emergency operation for 30 cases

目的探讨急症门-奇静脉断流加脾切除术对食管、胃底静脉曲张急性出血的治疗效果。方法回顾性分析30例急症门-奇静脉断流加脾切除术的临床资料;全组男25例,女5例,均为肝炎后肝硬化、门静脉高压、食管及胃底静脉曲张急性出血病例,全部均有脾功能亢进表现,肝功能Child A级11例,Child B级19例,前20例施行改良Sugiura式门-奇断流加脾切除术治疗,后10例施行选择性改良Sugiura式门-奇断流加脾切除术治疗。结果全组术后均检出白血球升高,25例血小板计数超300×109/L,25例术后平稳恢复,5例肝功能明显减退,大量腹水、少尿,2例轻度黄疸,经积极治疗全部康复出院。27例（90%）得到1~3年随访,在17例改良Sugiura手术中3例再出血,1例为食管静脉曲张出血,2例为门脉高压性胃病引起,后10例选择性改良Sug-iura手术均无再出血表现。结论改良Sugiura门-奇静脉断流加脾切除术是治疗门静脉高压、食管胃底静脉曲张急性出血的有效手术,选择性改良Sugiura式门-奇断流加脾切除术治疗更有其优越性。

Objective To explore the curative effect of porto-azygous vein disconnection plus splenectomy for acute bleeding of easophegeal and gastric fundal varices.Methods Clinical data of 30 patients with porto-azygous veins disconnection plus splenectomy for acute bleeding of easophegeal and gastric fundal varices were analyzed retrospectively.All patients were acute esophageal gastric fundal varicose bleeding of portal hypertension of post-hepatitis cirrhosis and all manifestated splenic hyperfunction.Eleven cases with Child A liver function and Child B in 19 cases.Modified Sugiura operation was performed in 20 cases and selective Sugiura operation in 10 cases.Results There were smooth recovered in 25 cases at postoperation.Liver dysfunction with ascites and oliguria appeared in 5 cases,light jaundice in 2 cases and all cases were recovered through vigorous treatment.Twenty-seven cases（90%） were followed-up for 1~3 years,among 17 cases undergone modified Sugiura operations,rebleeding appeared in 3 cases,and among 10 cases undergone selective Sugiura operations,no rebleeding case was found.Conclusion Modified Sugiura operation plus splenectomy is effective operation for acute bleeding of easophegeal and gastric fundal varices.Selective Sugiura operation plus splenectomy has the superiority for acute bleeding of easophegeal and gastric fundal varices.