门-奇静脉断流加脾切除术治疗门静脉高压症95例报告

Porta-azygous veins disconnection plus splenectomy to treat portal hypertension in 95 cases

目的探讨门-奇静脉断流加脾切除术对肝硬化、门静脉高压症导致食管、胃底静脉曲张的治疗效果。方法回顾性分析95例门-奇静脉断流加脾切除术的临床资料;全组男68例,女27例,均为肝炎后肝硬化,门静脉高压,食管、胃底静脉曲张病例,全部均有脾功能亢进表现,肝功能Child A级62例,Child B级33例。施行Hassab断流加脾切除术29例,施行改良Sugiura式门-奇断流加脾切除术41例,施行选择性改良Sugiura式门-奇断流加脾切除术25例。结果全组术后均检出白血球升高,血小板计数超300×109/L 25例,术后平稳恢复83例;肝功能明显减退、大量腹水、少尿12例,轻度黄疸2例,经积极治疗全部康复出院。85例(89.5%)得到1～3年随访,在29例Hassab手术中6例再出血(20.6%);41例改良Sugiura手术中5例再出血(12.19%),2例为食管静脉曲张出血,3例为门脉高压性胃病引起;25例选择性改良Sugiura手术均无再出血表现。结论选择性改良Sugiura门-奇静脉断流加脾切除术是现代治疗门静脉高压、食管胃底静脉曲张急性出血的有效手术,在三种断流术中具有合理性和优越性。

Objective To explore the therapeutic effect of porta-azygous vascular disconnection plus sple-nectomy for the treatment of portal hypertension. Methods Clinical data of 95 patients with porta-azygous veins disconnection plus splenectomy for portal hypertension were analyzed retrospectively. All patients were post- hepatitis cirrhosis and all had hypersplenism. Sixty-two cases had Child A liver function and Child B in 33 cases. Hassab operation was performed in 29 cases, modified Sugiura operation in 41 cases and selective Sugiura opera- tion in 25 cases. Results There were smooth recovered in 83 cases after postoperation. Liver disfunction with ascites and oliguria was found in 12 cases, light jaundice in 2 cases and all cases were recovered through vigorous treatment. Eighty-five cases （89.5%） were followed up for 1-3 years, among 29 cases of Hassab operation, postoperative rebleeding occurred in 6 cases （20.6%）; in 41 cases of modified Sugiura operations, postoperative rebleeding occurred in 5 cases （12.19%） and among 25 cases of selective Sugiura operations, no rebleeding case was found. Conclusion Selective modified Sugiura porta-azygous vein disconnection operation plus splenectomy is more superiority for acute bleeding of easophegous and gastric found us varioces.