门静脉高压症外科治疗45年回顾(英文)

Surgical treatment of portal hypertension: 45 year experience

目的 探讨门静脉高压症手术治疗的适应证、手术时机及术式的选择。 方法 将 4 5年来手术治疗的 912例门静脉高压症患者 ,按手术时间分为三个时间组 ,即 1978年以前 (A组 ) ,1978 1989年 (B组 ) ,1990 1998年 (C组 )。对每一时间段急诊与择期行分流手术、断流手术及断流术加分流术(联合术 )的疗效进行回顾性分析。 结果 ( 1) 912例患者中 ,A、B、C各组 ,分流术、断流术及联合术例数分别为 3 45例、13例、0例 ;84例、2 0 9例、0例 ;63例、2 0 4例和 63例。三组急诊手术例数分别为 4 5例、13例和 4例。 ( 2 )手术死亡率 :分流术A、B、C各组分别为 7.82 %、7.14 %和 0 ;断流术分别为 15 .3 8%、6.2 8%和 4 .94 % ;联合手术C组为 3 .5 1%。 ( 3 )脑病发生率 :分流手术 14 .3 7% ,断流手术 5 .68% ,联合手术 5 .77%。( 4 )再出血率 :分流手术 10 .78% ,断流手术 18.95 % ,联合手术 7.69%。 结论 ( 1)门静脉高压症手术适应证及手术时机 :有出血史的患者有无手术适应证取决于肝功能 ,肝功能差的尽量等待好转后再行手术治疗。对于无出血史的预防性手术仍有一定的价值 ,预防性手术施行与否可参照食道钡餐、彩超、内镜等。急诊手术呈下降趋势。 ( 2 )术式的选择 :断流手术呈增加趋势 。

To review the experience in surgery for 912 patients with portal hypertension. Methods The 912 patients were divided into three groups: before 1978 (group A), 1978 1989 (group B),and 1990 1998 (group C). The results were reviewed of portosystemic shunt (PSS), disconnection and disconnection plus PSS for emergency and elective operation at different periods. Results In the 912 patients of groups A, B, C, the number of PSS, disconnection, and PSS plus disconnection was 345, 13, 0; 84, 209, 0; 63, 204, 63, respectively. The number of emergency operation was 45,13 and 4 in each group. The operative mortality of shunt in the groups A, B, C was 7 82%, 7 14% and 0, respectively; that of disconnection in the groups A, B, C 15 38%, 6 28% and 4 94%; and that of PSS plus disconnection in group C 3 51%. Encephalopathy occurred in 14 37% of the PSS group, in 5 68% of the disconnection group, and in 5 77% of the disconnection plus PSS group. Rebleeding occurred in 10 78% of the PSS group, in 18 95% of the disconnection group, and in 7 69% of the disconnection plus PSS group. Conclusions Operative indications for the cirrhotic patients with portal hypertension depend on their liver function. For those patients with poor liver function, surgery is considered when their liver function is improved. We suggest prophylactic operation is valuable. Other indices from barium meal, color ultrasound, and endoscopy are also considered. The number of emergency operation has been decreasing. Since the 1980s, disconnection operation has been adopted increasingly. In our hospital, the number of patients receiving disconnection has been increasing from the early 1980s and the operation has almost replaced shunt operation in the 1990s. Disconnection combined with splenorenal shunt can lower the portal pressure and maintain the portal flow. Disconnection combined with splenorenal shunt seems to be a better procedure of choice.