联合断流与肠腔分流术治疗门静脉高压症100例疗效分析

Combined devascularization and mesocaval shunt for treatment of portal hypertension:analysis of 100 cases.

目的 探讨断流与肠腔分流联合手术的血流动力学变化及其临床效果。方法 对 1980～ 1995年采用联合手术治疗的 10 0例门静脉高压症进行回顾性分析。结果 分流术后自由门静脉压力 (FPP)下降 1 92kPa ,能够降低门静脉压力 ,防止出血 ;联合手术后FPP平均为 ( 2 46± 0 30 )kPa ,仍可保持高水平的向肝血流灌注 ,减少脑病发生。全组效果满意 ,无手术死亡。 89例随访 5～ 15年无复发出血 ,脑病 5 % ,总病死率 15 %。其中肝功能ChildC级 13例死于肝终末期病变 ,如肝衰、肝癌及肝肾综合征 ,5年生存率 94 5 % ,10年生存率 6 8 5 %。结论 联合手术具有断流术和外周型合理口径分流的特色 ,是断流和分流术两者优缺点互补 。

Objective To study the hemodynamic changes in combined portoazygous devascularization and mesocaval shunt for treating portal hypertension and the effect of this operation.Methods 100 cases of portal hypertension who received this combined operation from 1980 to 1995 were analyzed retrospectively.Results Free portal pressure(FPP)after shunt decreased to 1\^92 kPa,which decreased portal pressure and preserved with (2\^46±0\^30)kPa to maintain a good inflow to the liver and the encephalopathy rate was lowered.There was no death,and the effect was satisfactory.5～15 years follow up of 89 cases showed no rebleeding,with only 5% of encephalopathy and 15% of total mortality.Among them,13 cases of Child C died of late stage hepatopathy,such as liver failure,liver cancer and hepatorenal syndrome,with 94\^5% of 5 year survival rate and 68\^5% of 10 year survival rate.Conclusion This combined operation is characterized by complete devascularization of sustaining varices and distal partial shunt with logical diameter.A perfect combination of both shunt and devascularization,its one of the best choices currently available for treating portal hypertension in China.