门静脉高压症术后并发症和死亡原因的分析及防治

Analysis of postoperative complications in patients with portal hypertension and its management

目的分析门静脉高压症术后并发症和死亡的原因 ,探讨防治措施。方法回顾性分析 1988年 12月至 1998年 12月间手术治疗的门静脉高压症患者 30 2例。结果本组共发生术后并发症 42例 ,发生率为 13 9%。发生并发症的原因中有些与手术方法和技术有关 ,有些与疾病和患者的机体状况有关。影响术后并发症的主要因素有 :年龄大于 5 0岁、肝功能Ⅲ级、急诊手术、中度以上静脉曲张。随访时 6 4例已死亡 ,死亡原因主要为 :术后并发症、出血、肝性脑病、全身衰竭等。结论减少术后并发症的关键是规范手术操作 ,注重围手术期处理 ,尽量避免急诊手术 ,对年龄较大、肝功能较差、反复出血的患者尤应重视。对术后患者应经常随访 ,采取各种措施改善患者全身状况 。

ObjectiveTo analyze the postoperative complications and mortality in patients with portal hypertension and its prevention.MethodsFrom December 1988 to December 1998, we have surgically treated portal hypertension in 302 cases.ResultsForty-two(13.9%) patients had complications. Some complications were related to the operative method and the expertise, others were related to the disease and patients′ condition. The main relative factors of complications were: age over 50,liver function grade C, emergency operation, and moderate or severe esophageal varices. 64 patients died at follow-up of surgical complications, rebleeding, encephalopathy and systemic failure. ConclusionThe standard operative maneuver, perioperative intensive therapy and avoidance of emergency operation were important in reducing the complications. More attention should be paid to patients with old age, poor liver function and repeated bleeding. Postoperative patients should be regularly followed-up. Every measures should be undertaken to improve the patients′ general condition in order to lower bleeding, encephalopathy and mortality.