高位肠-腔人工血管架桥术联合门奇断流术治疗门脉高压症疗效观察

The effects of high mesocaval shunt combined with portal-azygous disconnection in the treatment of portal hypertension

目的探讨高位肠系膜上静脉-下腔静脉人工血管架桥术(简称高位肠-腔人工血管架桥术,HMCS)联合门奇断流术治疗门脉高压症的疗效。方法对2001—2011年收治的144例行高位肠-腔人工血管架桥术联合门奇断流术门脉高压症患者的临床资料进行回顾性分析。结果全组男89例,女55例;年龄19～55岁。肝炎后肝硬化119例,其他肝硬化25例。均有中-重度胃底食管静脉曲张。有1次以上出血史者128例。术前肝功能分级:Child A级86例,B级58例。均行HMCS+断流术。术后自由门静脉压力平均下降9 cmH2 O。白细胞及血小板计数均明显升高或恢复正常。术后并发症:切口感染4例,腹腔感染1例,发热12例,肝性脑病2例,人工血管内血栓形成1例,出现乳糜漏14例,以上并发症均通过非手术治疗治愈。1例死于肝肾综合征。随访106例患者6个月至10年,其中95人自觉比术前明显好转,无消化道再次出血、肝性脑病、腹水等症状,总有效率89.6%(95/106)。肝性脑病4例,人工血管内血栓形成3例,均通过非手术治疗治愈;上消化道出血复发4例,其中死亡3例,1例通过非手术方式止血治愈。结论高位肠-腔人工血管架桥术联合门奇断流术治疗门脉高压症并发症低,近、远期疗效好,是一种治疗门静脉高压有效的方法。

Objective To evaluate the efficacy of high mesocaval shunt（HMCS） plus portal-azygous disconnection for treatment of portal hypertension.Methods The clinical date of 144 patients with portal hypertension undergoing HMCS plus portal-azygous disconnection in our hospital from 2001 to 2011 were retrospectively analyzed.Results Of the patients,89 cases were male and 55 cases were female,whose ages ranged from 19 to 55 years.There were 119 cases of posthepatitic cirrhosis and 25 cases cirrhosis secondary to other causes.All the patients had moderate or severe esophageal and gastric fundal varices,and 128 cases had the history of bleeding more than once.Eighty-six cases were Child′s grade A and 58 cases were Child′s grade B in terms of liver function grades before operation.All the patients underwent HMCS plus portal-azygous disconnection.The free portal pressure of the patients decreased 9 cm H2O in average,and their white blood cells and platelet count significantly increased or returned to normal after surgery.The postoperative complications comprised four cases of wound infection,one case of intra-abdominal infection,12 cases of fever,two cases of hepatic encephalopathy,1 case of graft thrombosis and 14 cases of chylous leakage.All the complications mentioned above were resolved by non-surgical therapy.Only 1 patient died of hepatorenal syndrome.One hundred and six patients were followed up for 6 months to 10 years,of whom the subjective symptoms were obviously improved in 95 cases after surgery and they had no gastrointestinal rebleeding,hepatic encephalopathy,ascites or other symptoms,the total effective rate was 89.6%（95/106）.Hepatic encephalopathy occurred in four cases and graft thrombosis in three cases,which were all resolved by non-surgical treatment.Upper gastrointestinal rebleeding occurred in four cases,of whom three cases died,and 1 patient was cured by non-surgical treatment.Conclusions High mesocaval shunt plus portal-azygous disconnection is an effective treatment for portal hypertension,it with low complication incidence and better short as well as long term results.