摘要
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.
出处
《中国实用外科杂志》
CSCD
北大核心
1999年第11期663-665,共3页
Chinese Journal of Practical Surgery
关键词
断流术
分流术
门脉高压症
术式
Hypertension Portal Portaazygous disconnection Surgical Peritoneovenous shunt