胃左动脉在食管下段胃底切除术治疗门静脉高压症中的意义

The significance of the left gastric artery in the lower esophageal gastric fundus resection in portal hypertension

目的探讨胃左动脉在食管下段胃底切除术治门静脉高压症中的意义。方法在完成脾切除术后,将食管下段胃底切除术的剩余操作分解为三部分:贲门周围血管离断术(因素a)、食管下段胃底切除术(因素b)和结扎胃左动脉(因素c)。按析因设计分为8个试验组,分别测量各试验组的门静脉压力。结果 3个因素均效应显著(P<0.01);因素a与因素b之间的交互作用效应显著(P<0.05),即贲门周围血管离断术与食管下段胃底切除术之间存在交互作用。因素a与因素c之间的交互作用及因素b与因素c之间的交互作用效应均不显著(P>0.05)。结论保留胃左动脉的食管下段胃底切除术,能保证更多的向肝血流,是治疗门静脉高压症食管胃底静脉破裂出血的较合理术式。

Objective To explore the significance of the left gastric artery in the lower esophageal gastric fundus re- section in portal hypertension. Methods After splenectomy,the remnant of operation were divided into 3 parts ： pericardia de- vascularization（factor a）, terminal esophagoproximal gastrectomy（ factor b） and ligation of left gastric artery （factor c）. 8 groups were formed with permutation and combination of the 3 parts. Free portal pressures （FPP） of groups were respectively measured during the operation. Results The 3 main effects was statistically significant （ P 〈 0.01 ）. The interaction between factor a and factor b was statistically（ P 〈 0.05 ）. There was an interaction between peri6ardial blood vessel surgery and lower esophageal gastric fundus resection. The interaction between factor a and factor c was not statistically significant （ P 〉 0.05 ）. Conclusion Owing to more hepatopetal blood inflow,terminal esophagoproximal gastrectomy without ligation to left gastric ar- tery is logical operation for patients with esophageal varices in posthepatitic cirrhosis.