手术治疗门静脉高压症392例分析

A clinical analysis of 392 cases of surgical treatment of protal hypertension with operation.

目的 探讨在不同条件下，选择合理的治疗门静脉高压症的手术方式。方法 分析１９８９ ～１９９８ 年１０ 年间收治的３９２ 例门静脉高压症病人，其中断流术２１８ 例，门体分流术１１５ 例和选择性分流术５９ 例。结果 门体分流术中吻合口径在８ ～１２ｍ ｍ 组术前ＦＰＰ 显著高于其它组（ Ｐ ＜ ０－０１） ，术后ＦＰＰ 下降也较其它组明显（ Ｐ ＜ ０－０１）。断流术、门体分流术和选择性分流术术后再出血率分别为２０－１８ ％ 、１３－９１ ％ 和８－４７％ 。肝性脑病的发生率分别为３－６７ ％ 、８－７０ ％ 和３－３９％ 。手术死亡率分别为５－５０ ％ 、１－７４ ％ 和３－３９。结论 门静脉高压症外科治疗的三种术式各有其长处和不足，应根据病人的具体情况审慎选择。断流术是门静脉高压症外科治疗的主要术式；门体分流术吻合口径限制在６ ～８ｍ ｍ 为宜，肠腔侧侧分流术为常用术式；选择性分流术是一种较理想的术式，但技术难度较大。

Objective To explore the selection of reasonable operation under different conditions.Methods The data of 392 patients with portal hypertension surgically treated in our center from 1989 to 1998 were analyzed.Of the patients,218 were treated with portaazgous disconnection(PD),115 with portasystemic shunt(PS) and 59 with selective shunt(SS).Results In the 115 patients treated with PS,FPP was significantly higher in the patients with a diameter of the anastomotic stoma of 8～12mm than in those with a diameter of the anastomotic stoma more than 12mm or less than 8mm before the operation(P<0 01).After the operation,FPP in the former patients was markedly decreased as compared with the latter ones(P<0 01).The occurring rate of hemorrhage in patients treated with PD,PS or SS was 20 18%,13 91% and 8 47% respectively.The occurring rate of hepatic encephalopathy was 3 67%,8 70% and 3 39% while the operative mortality was 5 50%,1 74% and 3 39% respectively.Conclusion The three kinds of operation in surgical treatment of portal hypertension have their own advantages and disadvantages.Therefore,the selection of operation should be based on the actual needs of the patients.PD is the main operation way in surgical management of portal hypertension.When PS needs to be conducted,the diameter of the anastomotic stoma should be 6～8mm and the most usual operative approach is side-to-side PS in the intestinal cavity.SS is a good operation in treatment of portal hypertension but its conduction is fairly difficult.