食管胃底静脉曲张术后再出血的治疗(附58例报告)

Treatment of rebleeding in gastroesophageal varices after operation

目的 探讨食管胃底静脉曲张术后再出血的有效治疗方法。方法 对1980年1月～1996年1月收治的58例食管胃底静脉曲张术后再出血的病例的临床资料进行回顾性分析。结果 7例非手术治疗,51例手术治疗。手术治疗组中,急诊手术19例,择期手术32例。非手术治疗组死亡率为43%;手术组总死亡率为176%,其中急诊手术死亡率为368%(7/19),择期手术死亡率为63%(2/32)(P<0.05)。31例获随访05～12年,再出血率226%,肝功能维持和改善率903%,食管静脉曲张好转率567%,脑病出现率64%,劳动力恢复正常者占839%。结论 对出血量大,反复多次出血或伴有食管胃底静脉曲张进行性加重者均应手术治疗,手术尽可能择期进行。手术治疗效果良好。

Objective To study the effective treatment for rebleeding in postoperative gastroesophageal varices (GEV). Methods The clinical data of 58 postoperative rebleeding cases of GEV from January 1980 to January 1996 was retrospectively analysed. Results Of the 58 cases, 7 were treated by non operative management; 51 by surgery, including emergent operation in 19, elective operation in 32. The mortality in non operation group was 43%, in surgery group 17.6% (in emergent operation group 36.8%, and elective operation group 6.3%, P<0.05). Thirty one patients were followed up for 0.5～12 years. Of them, rebleeding rate was 22.6%, liver function improved or unchanged was in 90.3%, GEV disappeared or improved in 56.7%, encephalopathy occurred in 6.4%, and the working ability returned to normal in 83.9% of the patients. Conclusions If the patient sufferring from massive bleeding, repeat bleeding or the GEV exacerbating progressively, they should receivce operation. The operation should be done electively if possible. The effect of operation on rebleeding patient with GEV is good.