肝功能Child-Pugh C级的门静脉高压症患者急诊断流术后疗效分析

Postoperative effects of emergency PCDV in portal hypertensive patients with hepatic function classed Child-Pugh C

目的 对 1 6例肝功能 Child- Pugh分级 C级的门静脉高压症患者实施急诊断流术后的疗效进行分析。期望在手术时机、适应症、防治并发症等方面提出一些见解。方法 1 6例 Child- Pugh C级门静脉高压症患者 ,均是乙型肝炎后肝硬化。急诊内窥镜证实为食管下段曲张静脉破裂大出血时 ,采用“脾切除加贲门周围血管离断术”实施急诊止血 ,术后积极配合以内科为主的综合治疗措施。结果 ( 1 )死亡率、术后复发出血率、门静脉高压性胃粘膜病变 ( PHG)发生率分别为 1 2 .5 %、6.2 5 %、6.2 5 % ;( 2 )生存者随访至今无一例出现严重的并发症。结论 ( 1 ) Child- Pugh C级门静脉高压症患者发生食管曲张静脉破裂大出血时并非手术禁忌 ,但需要严格掌握其适应症 ,并重视手术前准备及围手术期处理 ;( 2 )术后复发出血和发生 PHG均可以非手术疗法治愈。

Objective To put forward views on opportunity,indication and complication in patients after emergency PCDV Methods 16 cases of classed Child Pugh C's portal hypertension,who were suffered from posthepatitic cirrhosis (hepatitis B) and confirmed to be lower esophageal variceal splitting hemorrhage by emergency electric gastroscopy, were carried out splenectomy and porto cardia disconnection to stop bleeding. Comprehensive measure was used combining with internal medicine Results Mortality,recurring hemorrhage rate and PHG morbidity were 12 5%,6 25% and 6 25%, respectively.No severe complication was found in survivals who were following up Conclusions It's not a contraindication to patients with classed Child Pugh C's portal hypertension suffered from occurring esophageal variceal splitting greatly hemorrhage.It's necessary to evaluate the indication,pay attention to preoperative preparation and preoperative treatment.Reoccurring hemorrhage and PHG after surgery can be cured by no operation treatment