选择性断流术与断流加分流术治疗门静脉高压症24例分析

Splenorenal shunt combined with devasularization and selected splenectomy alone for portal hypertension

目的观察选择性断流术与断流加分流术治疗门静脉高压症上消化道出血的临床效果。方法回顾性分析10例采用断流术加脾肾分流术(联合组)与14例选择性断流术(断流组)患者的临床资料,比较术前、术后及手术前后下降的自由门静脉压、术前及术后1个月行胃镜检查的食道静脉曲张及门脉高压性胃黏膜病变的变化情况。结果两组均无无手术死亡、再出血及肝性脑病发生。断流组FPP降低(4.25±0.74)cmH2O,联合组降低(7.49±1.23)cmH2O,联合组降压效果明显优于断流组(t=-8.078,P<0.01)。胃镜检查食道静脉曲张均有明显好转,组间无差异(P>0.05),而门脉高压性胃黏膜病变好转情况两组间有统计学差异(P<0.05)。结论分流加断流联合手术门静脉降压及胃黏膜病变改善均明显好于选择性断流术,故联合手术应作为肝硬化门静脉高压症出血治疗的首选术式。

Objective To evaluate the effect of splenorenal shunt combined with devasularization and selected splenectomy alone for portal hypertension with upper digestive tract hemorrhage.Methods We reviewed retrospectively 10 patients with portal hypertension who had been treated by splenorenal shunt combined with devasularization and 14 patients who had been treated by selected splenectomy alone.Their free portal pressure（FPP） during the operation,and gastroscope after the operation wre measured respectively.Results There was no operative mortality,re-bleeding and hepatic encephalopathy.The FPP after selected splenectomy alone（4.25±0.74cmH2O） was decreased more than that after combing operation（7.49±1.23cmH2O）（t=-8.078,P〈0.01）.The portal hypertension gastropathy in combing operation was better as compared with those in selected splenectomy alone（P〈0.05）.Conclusion The decrease FPP and the portal hypertension gastropathy in combing operation group were better as compared with those in selected splenectomy group.Splenorenal shunt combined with devasularization should regarded as the method of choice in treating portal hypertension with hemorrhage.