联合断流术与选择性断流术治疗门静脉高压症的疗效观察

Comparative therapeutic effects of Combined and selective devascularization procedures in the surgical treatment of portal hypertension

目的评价联合断流术的疗效。方法回顾性分析2009年9月至2013年9月我院手术治疗门静脉高压症并上消化道出血患者46例的临床资料,其中行选择性断流术28例(断流组),选择性断流联合食管下段横断术18例(联合组)。结果两组术中自由门静脉压力(FPP)下降程度、出血量、手术时间、术后住院时间、术后近期再出血率比较无统计学差异(P>0.05)。术后食管及胃底静脉曲张静脉消失率为联合组94.4%(17/18)和断流组64.3%(18/28),有统计学差异(P<0.05)。结论联合断流术食管胃底静脉曲张消失率较高,但术后近期再出血率与选择性断流术相差不大,我们认为临床上全身情况较好的患者适合选择联合断流术。

Objectives To evaluate tile therapeutic effects of combined devascularization procedure. Methods Forty-six patients with portal hypertension and upper gastrointestinal bleeding were included in this study and the clinical data were analyzed respectively. of 46 cases, 28 underwent the surgical procedure of selective devascularization （selective group） and 18 received selective devascularization combined with modified Sugiura procedure （combined group）. Results There were no significant difference between the two groups in intraoperative blood loss,operation time,hospitalization days, free portal pressure （FPP） changes, and postoperative rebleeding （P〉0.05）. Postoperative esophageal varices disappearance rate for combined group was 94.4% （17/18） and selective group was 64.3% （18/28）, with statistical difference （P〈0.05）. Conclusion In the present study, postoperative esophageal varices disappearance rate in patients with combined devascularization was higher. Although the rate of postoperative rebleeding was almost the same with selective devascularization,combined devascularization may be a better choice for the patients with good general condition.