门静脉高压不同手术后并发症分析

Surgical treatment of portal hypertension clinical analysis

目的:总结门静脉高压患者不同类型手术的并发症及预后。方法:对45例不同病因类型的门静脉高压患者手术治疗的临床资料进行回顾性分析,其中贲门周围血管离断术18例(断流组),经腹改良式Sugiura断流术17例(横断流组),改良冠-腔分流术10例(冠腔分流组),对术后并发症进行随访并分析总结。结果:45例患者均痊愈出院,术后发生多见并发症21例,其中术后急性腹腔出血1例,切口感染1例,肺部感染2例,腹水3例,门静脉系统血栓6例,脾窝积液1例,术后再出血5例,术后食管吻合口狭窄2例。术后平均住院时间18 d。术后随访2～72个月,45例全部获得随访资料,3例死亡,其中1例为肝硬化癌变,2例为肝功能衰竭。冠腔分流组并发症低于其他2组(P<0.01);冠腔分流组无死亡,断流组死亡1例,横断流组死亡2例,死亡率冠腔分流组亦低于其他2组(P<0.01)。结论:合理选择不同外科术式治疗门静脉高压,有效预防及处理术后并发症,可以达到良好的治疗效果,改良冠-腔分流术作为部分门静脉高压患者的治疗术式有待于进一步研究。

Objective： To summarize the efficacy and prognosis in different types of surgical treatment for portal hypertension patients. Methods： To analysis the intraoperative related indica- tors, the postoperative complications and follow-up information of surgical treatment for different causes of portal hypertension in 45 patients. Among of all, pericardial blood vessel disarticulation were performed in 18 patients, 17 patients in modified sugiura devascularization and 10 patients in modified left gastric venous-caval shunts. Resulls： All perioperative patients were alive and common post- operative complications occurred in 21 cases, among of all, The postoperative acute abdominal bleed- ing in 1 case, incision infection in 1 case, pulmonary infection in 2 cases, ascites in 3 cases, portal vein thrombosis in 6 cases, spleen nest effusion in 1 case, postoperative bleeding in 5 cases, esophageal anastomotic stricture in 2 cases, the average hospitalization time 18 days, Follow-up time was 2 to 72 months, 45 cases were all followed up. Comparison of complications between the three groups, the modified left gastric venous shunt group of complications is lower than the other two groups（P〈0.01）; There was no death cases in the modified left gastric venous shunts group, and 1 in disarticulation group, 2 in Modified Sugiura devascularization group, In mortality comparison, The former group was lower than the latter two groups. Conclusion： Reasonable choice different surgical operation treat- ment of portal hypertension and effective prevention and treatment of postoperative complications can achieve a good therapeutic effect, the modified left gastric venous shunts as part of the treatment of portal hypertension patients procedures need to be further research and perfect.