脾切除贲门周围血管断流术在PHT并上消化道大出血急诊手术中应用

Splenectomy with pericardia vascular disconnection in PHT and upper digestive tract hemorrhage in emergency operation application

目的探讨脾切除贲门周围血管断流术在PHT并上消化道大出血急诊手术中应用。方法 2006年1月至2010年1月急诊脾切除贲门周围血管断流术治疗肝硬化门静脉高压症并消化道大出血患者38例临床资料进行总结。结果本组38例采取急诊脾切除贲门周围血管断流术均顺利完成手术,门静脉断流前测压(34.6±6.2)cmH2O;门静脉断流后测压(28.6±4.7)cmH2O,术后上消化道出血全部停止,手术止血率达100%;发生并发症6例(15.79%),随访2年,发再出血4例,再出血率10.52%。结论对于肝硬化门脉高压症食管、胃底静脉曲张破裂引起上消化道大出血保守治疗无效,采取急诊脾切除贲门周围血管断流术有效降低门静脉压力,断离门奇静脉间侧支循环,具有止血效果显著,手术简单、创伤小,便于基础医院开展。

Objective To investigate the splenectomy with pericardia vascular disconnection in PHT and upper digestive tract hemorrhage in emergency operation application.Methods From 2006 January to 2010 year in January emergency splenectomy with pericardia vascular disconnection for the treatment of hepatic cirrhosis with portal hypertension and gastrointestinal bleeding in patients with the clinical data of 38 cases were summarized.Results the 38 cases with emergency splenectomy with pericardia vascular disconnection were successfully completed operation,portal venous flow before manometry with （34.6±6.2） cmH2O,portal vein after pressure of（28.6±4.7） cmH2O,postoperative hemorrhage of upper digestive tract bleeding to stop all,operation rate was 100%,complications occurred in 6 patients （15.79%）,follow-up in 2years,hair and hemorrhage in 4 cases,the rate of rebleeding in 10.52%.Conclusion For hepatic cirrhosis portal hypertension esophageal,gastric varices caused by upper digestive tract hemorrhage refractory to conservative treatment,emergency splenectomy with pericardia vascular disconnection effectively decrease portal pressure,portal azygos disconnection between collateral circulation,having hemostatic effect is remarkable,has the advantages of simple operation,small wound,convenient base hospital.