脾动脉及胃冠状静脉主干结扎在肝硬化门静脉高压症上消化道出血中的应用

Ligation of splenic artery and gastric coronary vein trunk in treatment of emergent epatocirrhosis portal hypertention with upper gastrointestinal bleeding

目的评价脾动脉及胃冠状静脉主干结扎治疗肝硬化门静脉高压症上消化道出血的效果。方法回顾性分析60例肝硬化门静脉高压症上消化道出血患者的临床资料,其中行脾动脉及胃冠状静脉主干结扎30例(观察组),行脾切除+贲门周围血管离断术30例(对照组)。结果观察组病死率低于对照组(P<0.05)手术时间短于对照组(P<0.01),术中出血量少于对照组(P<0.01)。两组手术前后白细胞、血小板及肝功能相关比较差异均无统计学意义(P>0.05)。结论相对于传统手术,脾动脉及胃冠状静脉主干结扎具有操作简捷、创伤小、止血确切等特点,并可降低病死率,尤其适合在无脾动脉栓塞及内镜止血等条件的基层医院开展。

Objective To evaluate the efficiency and safety of ligation of splenic artery and gastric coronary vein trunk in treatment of emergent hepatocirrhosis portal hypertention with upper gastrointestinal bleeding .Methods Sixty cases of hepatocirrhosis portal hypertention with upper gastrointestinal bleeding admitted during 2005 and 2013 were divided into two groups .The observation group （ n =30）and the control group （ n =30）and their clinical data was retrospectively analyzed .The observation group underwent the procedure of pericardial devascularization and splenectomy ,while the control group experienced ligation disconnection which com-bined splenic artery ligation with gastric coronary vein trunk ligation .Results The mortality rate of observation group was lower than that of control group（ P 0.05）.Conclusion Ligation of splenic artery and gastric coronary vein trunk has been characteristic of easy operation ,less invasion and exact hemostasis ,which is suitable to be carried out in county hospitals without splenic artery embo-lization and endoscopic hemostasis .