肝硬化门静脉高压症上消化道大出血的手术时机选择

Operation time selection for variceal bleeding of portal hypertension induced by hepatic cirrhosis

目的 探讨肝硬化门静脉高压症上消化道大出血患者的手术时机和疗效.方法 回顾性分析2006年1月至2012年1月我院收治的319例肝硬化门静脉高压症性上消化道大出血患者的临床资料.60例仅行保守治疗（A组）,84例保守治疗无效后急诊行脾切除加贲门周围血管离断术（B组）,175例保守治疗成功止血后择期行脾切除加贲门周围血管离断术（C组）.结果 B、C组术后并发症发生率分别为15.7%,2.9%,差异有统计学意义（P＜0.05）;A、B、C三组的死亡率分别为53.3%（32/60）,16.7%（14/84）,2.3%（4/175）,组间比较差异有统计学意义（P＜0.05）.结论 肝硬化门静脉高压症上消化道大出血患者经非手术治疗48 h后无活动性出血可行择期手术治疗,如经保守治疗无效后应尽早行急诊手术治疗.

Objective To explore the best timing and efficacy of surgery for variceal bleeding of portal hypertension of cirrhotic patients. Methods The clinical data of 319 patients with cirrhotic portal hypertension variceal bleeding admitted to Wuhan Union Hospital from Jan 2006 to Jan 2012 were retrospectively analyzed. There were 60 patients only receiving conservative therapy（ group A） ,84 patients failing conservative therapy and receiving emergency splenectomy plus perieardial devascularization surgery （group B）,and 175 patients receiving elective splenectomy plus perieardial devaseularization after successful conservative therapy（group C）. Results The complication rates of group B and C were 15.7% （ 11/84 ） and 2.9% （5/175） respectively（ P 〈 0.05 ） ;The mortality of group A, B and C were 53.3% （ 32/ 60）, 16.7% （14/84） and 2.3% （4/175） respectively, and there were significant differences in the levels of mortality among all the three groups （ P 〈 0.05 ）. Conclusion For the patients of cirrhotic portal hypertension variceal bleeding, the elective surgery should be performed if patients have not continuing bleeding after 48h conservative therapy. The salvage surgery should be done as early as possible if the conservative therapy is not effective.