肠腔分流并选择性冠状血管缝扎术治疗成人门静脉海绵样变性引起的上消化道出血

Mesocaval shunt plus portaazygous disconnection for portal hypertensive variceal bleeding caused by cavernous transformation of the portal vein in adults

目的探讨肠腔分流并选择性冠状血管缝扎术对成人门静脉海绵样变性的治疗作用及其临床价值。方法对26例成人门静脉海绵样变性行肠腔分流、脾动脉结扎、选择性冠状静脉缝扎术治疗患者的临床资料进行回顾性分析。结果本组无手术死亡病例，分流术后自由门静脉压力为（24．8±2．7）cmH20，与术前的（34．4±4．7）cmH20比较差异有统计学意义（t=12．30，P〈0．01）。术后并发轻微肝性脑病1例，应激性溃疡出血1例，均通过非手术治疗后痊愈。23例得到随访，随访时间6个月～4．5年，无再出血病例。结论肠腔分流并选择性胃冠状血管缝扎术对成人门静脉海绵样变性是安全、有效、合理的手术方式。

Objective To investigate the clinical effect of mesocaval shunt and selective coronary vein ligation for portal hypertension caused by cavernous transformation of the portal vein in adults. Methods The clinical data of 26 adult patients with portal hypertensive variceal bleeding caused by cavernous transformation of the portal vein treated by mesocaval shunt plus splenic artery and coronary vein ligation were analyzed retrospectively from 2001 to 2011. Results There was no operative deaths, free portal vein pressure decreased postoperatively, differences were significant before and after shunt （ 34.4 ± 4. 7） cm H20 vs. （24. 8±2. 7） cm H20, t=12. 30,P 〈0. 01. Postoperative complications included slight hepatic encephalopathy in 1 case, stress ulcer bleeding in 1 case, which were cured by conservative treatment. 23 cases were followed up from 6 months to 4. 5 years, and there was no bleeding case. Conclusions Mesoeaval shunt plus selective vascular ligation for portal hypertensive variceal bleeding caused by cavernous transformation of the portal vein in adults is safe and effective.