保留食道旁静脉选择性断流术治疗门静脉高压症临床分析

Clinical analyzed of esophageal by varical-preserving with selective devascularization on portal hypertension

目的探讨选择性贲门周围血管离断术治疗门静脉高压症的临床效果。方法回顾分析2004年1月～2010年3月收治90例经选择性贲门周围血管离断术治疗肝硬化合并门静脉高压症病人的临床资料。结果术后FPP平均下降6±7 cmH2O;并发症发生率为22.2%。肝功能Child C级血胆固醇<3.0 mmol/L时术后并发症发生率有统计学意义(P<0.05);手术死亡率3.1%,主要死亡原因为上消化道再出血并发肝性脑病、多器官功能衰竭。获得随访1年、3年及5年再出血率分别为3.3%、5.6%及4.8%。结论选择性断流术合理地保留了机体的自发性分流,既保证入肝血量又降低门静脉压力,是一种较理想的断流术式。注重围手术期处理,肝功能较差、反复出血的患者尤应重视。

Objectives To investigate the clinical effects of selective devascularlzation procedures in the surgical treatment of portal hypertension. Methods The clinical data of 90 patients with the selective devascularization therapy on portal hypertension secondary to liver cirrhosis were analyzed retrospectively from January 2004 to March 2010. Results The incidence rate of postoperative complication was 22. 2% and FPP average decrease was 6±7cmH2O. The incidence of postoperative complication was increased significantly in patients with liver function of child C grade, Serum cholesterin 〈 3.0 mmol/L （ P 〈 0. 05 ） ; The operative mortality was 3. 1% and the major cause of death was recurrent upper gastrointestinal bleeding combined with hepatic encephalopathy and multiple organ dysfunction syndrome. The 1 - , 3 - , 5 - year incidence rates of upper gastrointestinal rehaem onyhagia were 3.3% ,5.6 and 4. 8% respectively. Conclusions The selective devascularization procedure reasonably preserves the patient ＇ s capacity of spontaneous blood diversion, thus helps achieving a dynamic balance which guarantees both blood flow into the portal vein and reduction of the portal vein pressure. This appears to be an optimal procedure in the treatment of portal hypertension. More attention should be paid to patients with poor liver function and repeated bleeding.