贲门周围血管断流术治疗肝硬化门静脉高压症

Gastroesophageal devascularization for the treatment of cirrhotic portal hypertension

目的评估贲门周围血管离断术治疗肝硬化门静脉高压症合并食管胃底曲张静脉破裂出血的效果。方法回顾性分析1996年1月至2007年10月间收治的85例肝硬化门静脉高压患者接受贲门周围血管离断术的资料。结果本组随访率为78％。全组患者术后1、3和5年生存率分别为95％、88％和82％，肝功能ChildA级与ChildB级患者术后生存时间之间相比差异有统计学意义（P〈0．05），1、3和5年出血率分别为6％、16％和28％，肝性脑病发生率为7％。贲门周围血管离断术后7d时患者丙氨酸转氨酶、天门冬氨酸转氨酶和血清白蛋白已恢复至术前状态。结论贲门周围血管离断术是治疗门静脉高压症食管胃底曲张静脉破裂出血的可靠手段，肝功能储备是影响患者术后长期生存的关键因素。

Objective To evaluate the therapeutic effect of gastroesophageal devasculariztion on cirrhotic portal hypertensive bleeding. Methods Clinical data of 85 cirrhotic patients with portal hypertentsive bleeding undergoing gastroesophageal devascularization were retrospectively analyzed. Results The following-up rate was 78%. The 1-yr, 3-yr and 5-yr survival rate was 95%, 88% and 82% respectively. There was significant difference in survival time after devascularization between patients of Child-Pugh A and Child-Pugh B. For the whole group the 1-yr, 3-yr and 5-yr recurrent bleeding rate was 6% ,16% and 28% and postoperative hepatic encephalopathy was 7%. ALT, AST and ALB recovered to pre-operative level on post-operative day 7. Conclusions Gastroesophageal devascularization was an effective therapy in treating portal hypertensive variceal bleeding. Liver function remains a significant factor influencing long term survival.