联合断流术治疗食管静脉曲张出血的临床研究及远期疗效观察

The Clinical Study and Observation of long-term effect of Combined Portoazygos Disconnection for Esophageal Variceal Bleeding

自1981年1月以来,行联合断流术治疗门脉高压症食管静脉曲张出血102例,手术死亡率为6.9%。随访1～8年的生存率为85.7%,食管静脉曲张减轻或消失者为90%,未发现肝性脑病症状。远期死亡9例(14.3%),再出血4例(6.3%)。资料表明,这种手术既阻断了胃外又阻断了胃壁内的门-奇静脉交通血流,止血效果肯定而持久。由于未降低门静脉压力,故有利于维持肝脏的血流灌注。肝功能状况是决定治疗效果的主要因素。文章提出了选择手术适应证的条件。

Since Jan.1981,the combined portoazygos disconnection had been per- formed on 102 patients with esophageal variceal bleeding.The operative mortali- ty was 6.9%.During 1-8 years follow-up period,the survival rate in average was 85.7%,and the esophageal varices relieved or disappeared in 90% patients,no en- cephalopathy occured.There were long-term death in 9 cases(14.3%),rebleeding 4 cases (6.3%).The material showed that this operative procedure interrupted the communication between the portoazygos vein with extragastric and intramural of the stomach and esophagus,so the effect of stoping hemorrage was definite and persistant.Because the portal vien pressure was not decreased,it was favorable for maintaining the hepatic blood perfusion.Keeping good hepatic function was the main curative factor in these cases.The indication for this selective operation had been discussed in this paper.