脾静脉-下腔静脉人工血管架桥术加贲fIN围血管缝扎术治疗门脉高压26例疗效观察

Effect observation of spleen vein-inferior vena cava artificial vascular bypass and cardiac peripheral vascular joint firm surgical treatment of portal hypertension in 26 cases

目的探讨脾静脉．下腔静脉人工血管架桥术加贲门周围血管缝扎术治疗门脉高压的疗效。方法对郑州大学第一附属医院自2006年12月至2012年1月26例门脉高压症患者行脾切除加睥静脉一下腔静脉人工血管架桥术加贲门周围血管缝扎术治疗的临床资料进行回顾性分析，对手术并发症、病死率，近远期疗效及再出血率进行追踪统计。结果本研究无死亡病例，无肝功能衰竭、肝肾综合征及肝肺综合征，其他并发症：轻度肝性脑病1例，人工血管血栓形成3例，切口感染1例，肺部感染1例，切口感染、肺部感染、肝性脑病均通过非手术治疗后痊愈，人工血管血栓形成2例通过溶栓、抗凝治疗后症状消失。术后再出血2例，1例为胃黏膜病变，药物治疗痊愈，1例为人工血管血栓形成导致食管静脉曲张破裂出血，经内镜套扎止血后出血停止。术后26例脾亢完全缓解，18例腹水患者中17例患者的腹水明显消退，术后1个月21例患者肝功能较术前改善，5例无明显变化。结论脾静脉一下腔静脉人工血管架桥术加贲门周围血管缝扎术能很好地治疗门脉高压所致的脾亢、腹水及消化道出血，改善肝功能，其在降低术后再出血率、控制腹水方面优于脾切断流术。

Objective To investigate the effect of spleen vein-inferior vena cava artificial vascular bypass and cardiac peripheral vascular joint firm surgical treatment of portal hypertension. Methods From December 2006 to January 2012, 26 patients with portal hypertension patients splenectomy plus spleen vein-inferior vena cava artificial vascular bypass and cardiac peripheral vascular joint firm surgical treatment were retrospectively analyzed, the operation complications, mortality rate, the close, long-term efficacy and re bleeding rate were tracking statistics. Results All cases had no death, no liver failure, hepatorenal syndrome （HRS） or liver lung syndrome, mild hepatic encephalopathy in 1 case, artificial vascular thrombosis in 3 cases, incision infection in 1 case, pulmonary infection in 1 case, incision infec- tion, pulmonary infection, hepatic encephalopathy all through the non-operative treatment get cured, arti- ficial vascular thrombosis in 2 cases through the thrombolysis and anti-coagulation after treatment, the symptoms disappeared. Postoperative bleeding in 2 cases, 1 case of gastric mucosa lesions, drug cured, and 1 case of artificial vascular thrombosis cause esophagus varicosity burst hemorrhage, stop bleeding af- ter the endoscopic ligation hemostasis. Twenty-six cases of post-operative hyperactivity of spleen complete remission, 17 cases ascites subsided in 18 cases with ascites, after one month, 21 cases＇ liver function improved, 5 cases had no obvious change. Conclusions Spleen vein-inferior vena cava artificial vascu- lar bypass and cardiac peripheral vascular joint firm technique can be a very good treatment of hypers- plenism caused by portal hypertension hyperactivity, ascites and gastrointestinal bleeding, can improve the liver function, reduce the postoperative bleeding rate, control ascites superior spleen cutting flow technique.