食管胃底静脉曲张破裂出血内镜治疗失败后再手术

Open esophagastric devascularization in recurrent variceal bleeding after endoscopic therapy

目的 比较内镜治疗后贲门周围血管离断术与未经内镜治疗患者贲门周围血管离断术治疗食管胃底曲张静脉破裂出血的疗效.方法 2005年6月至2010年6月期间共完成贲门周围血管离断术230例,其中肝炎后肝硬化202例,酒精性肝硬化28例.A组16例,为内镜治疗（套扎、栓塞）后再行贲门周围血管离断术；B组214例,直接行贲门周围血管离断术.结果 A组平均手术时间为（198±59）min,平均出血（750±120）ml,术后平均住院（11±2）d；B组平均手术时间为（120±26）min,平均出血（250±43）ml,术后平均住院（7±1）d.两组的平均手术时间、术中出血量、术后住院时间之间相比差异有统计学意义（均P＜0.05）.230例患者中获得随访212例,随访率为92.2％,术后平均随访2.5年（1～6年）,死亡率为4.2％,再出血率为5.7％.结论 内镜治疗后食管胃底周围组织纤维化、质硬,明显增加手术难度,手术时间、术中失血量较单纯贲门周围血管离断术明显增加,故对于适合行手术治疗的门静脉高压症患者应首选贲门周围血管离断术.

Objective To compare the effect of naive porto-azygous devascularization and that as a remedy therapy after a failed endoscopy for the treatment of bleeding portal hypertension.Method From June 2005 to June 2010,230 portal hypertension patients were treated with porto-azygous devascularization,among them,202 cases were of portal hypertensive cirrhotics,28 cases of alcoholic cirrhosis.Group A （16 patients）received remedial porto-azygous devascularization after endoscopic treatment failed （esophageal variceal ligation,esophageal variceal selerotherapy）.Group B（214 patients）received naive porto-azygous devascularization.Results The average operation time in group A was 198 min（115-335）min,mean bleeding amount was 750 ml（300-2000）ml,average post-operative hospital stay was 11 days （8-15）days.The average operation time in group B was 120 min（90-190）min,mean blood loss was 250 ml（150-500）ml,average post-operative hospital stay was 7 days（6-9）days.The average operation time,bleeding amount and post-operative hospital stay was significantly different between the two groups （P〈 0.05）.212（92.2%）patients were followed up,and the mean follow-up time was 2.5 years （1-6）years,mortality rate was 4.2%,rebleeding rate was 5.7%.Conclusions Surrounding the perioesophageal and gastric tissues were fibrotic and hard after the endoscopic treatment,this significantly increased the difficulty of surgery,therefore,porto-azygous devascularization is the choice of therapy for portal hypertension patients.