食管胃底静脉曲张破裂出血内镜治疗失败后再手术与直接手术疗效比较

Comparison of Efficacy of Reoperation after Failure Endoscopy vs Direct Operation for the Treatment of Esophageal Gastric Fundus Variceal Bleeding

【目的】比较内镜治疗失败后再手术与直接手术治疗食管胃底曲张静脉破裂出血的疗效。【方法】选取本院126例食管胃底静脉曲张破裂出血患者，其中试验组72例，为内镜治疗后再行贲门周困血管离断术患者；对照组54例，为直接行责门周围血管离断术患者，比较两组患者临床特征。【结果】试验组与对照纽的平均手术时间分别为（180±74）min，（130±41）min；术中出血量分别为：（680±150）mL，（320±110）mL；术后住院时间分别为（12±3）d，（7±2）d；两组间相比差异均具有显著性（P〈0．05）。126例患者随访率为95．23％，试验组与对照组复发率分别为11．59％、7．84％，病死率分别为7．24％、3．92％，3年生存率分别为92．75％、98．07％，两组比较差异有显著性（P〈O．05）。【结论】内镜治疗后再手术者增加了手术难度的同时不利于患者的预后，因此对于有手术治疗指征的门静脉高压症患者应首选贲门周围血管离断术治疗。

[Objective] To compare the efficacy of reoperation after failure endoscopy vs direct operation for the treatment of esophageal gastric fundus variceal bleeding. [MethodslTotally 126 patients with esopha- geal gastric fundus variceal bleeding in our hospital from Jan. 2007 to Jan. 2007 were chosen. The experimental group（ n =72） underwent periesophagogastric devascularization after endoscopic therapy. The control group（ n =54） underwent periesophagogastric devascularization directly. Clinical features of patients in two groups were compared. [Results] The average operation time of experimental group and control group were （180 ± 74） min and （ 130 ± 41 ） rain respectively, and intraoperative bleeding volume were （ 680 ± 150） mL and （ 320 ±ll0）mL respectively, and the postoperative hospital stay were （12＋3）d and （7±2）d respectively, and there were significant differences between two groups（ P 〈0.05）. The follow up rate of 126 patients was 95.23 %. The recurrence rate of experimental group and control group were 11.59 % and 7.84% respectively, and the mortality rate were 7.24% and 3.92% respectively, and 3-year survival rate were 92.75% and 98.07% re- spectively, and there were significant differences between two groups（ P 〈0.05）. [Conclusion] Reoperation after endoscopic therapy can increase the difficulty of the operation, but is not benefit for the prognosis of pa- tients. Therefore, periesophagogastric devascularization for the treatment of portal hypertensive patients with surgery indications is the first choice.