保脾断流术在肝功能不佳并门静脉高压上消化道出血患者中的应用效果分析

Analysis on therapeutic effect of selective paraesophagogastric devascularization without splenectomy for treatment of patients with liver dysfunction combined with portal hypertension with upper gastrointestinal hemorrhage

目的：探讨保脾断流术在肝功能不佳并门静脉高压上消化道出血患者中的应用效果。方法：选取肝功能不佳并门静脉高压上消化道出血行保脾断流术的患者38例,记录所有患者手术前后自由门静脉压力,分别于术前和术后7 d对患者血象及肝功能指标进行检测,记录患者术后并发症和住院时间,并对出院患者进行长期随访,观察患者再出血发生情况及生存情况。结果：38例患者手术前自由门静脉压力（37.2±6.8）cm H2O,术后自由门静脉压力（32.1±6.5）cm H2O,较术前下降13.7%,差异具有统计学意义（t=2.533,P〈0.05）;患者术后7 d时,WBC和PLT分别为（7.3±5.4）×109/L和（113.5±56.7）×109/L,均高于术前（P〈0.05）;38例患者术后并发症总发生率34.2%;34例顺利完成随访,随访完成率94.4%（34/36）,随访时间9~58个月,中位随访25个月,随访中均未出现再次出血,总体生存率92.1%（35/38）。结论：保脾断流术应用于肝功能不佳并门静脉高压上消化道出血患者具有较好的近期和远期止血效果,对肝脏影响较小,减少术后并发症的发生。

Objective： To investigate the application effect of selective paraesophagogastric devascularization without splenectomy for treatment of patients with liver dysfunction and portal hypertension with upper gastrointestinal hemorrhage. Methods： 38 cases of patients with liver dysfunction and portal hypertension with upper gastrointestinal hemorrhage were selected from March2011 to April 2014 in the department of Hepatobiliary Surgery in our hospital. The freedom portal pressures before and after surgery of all patients were recorded. Preoperative and postoperative 7d,the liver function parameters were detected, respectively. The postoperative complications and length of hospital stay were recorded. Long- term follow- up for discharged patients, the incidence of rebleeding and survival were observed. Results： The freedom portal pressure of 38 patients before surgery was（37.2±6.8）cm H2 O, and after surgery was（32.1±6.5）cm H2 O, which was decreased13.7% compared with before surgery, the difference was statistically significant（t=2.533, P0.05）.When after surgery 7d, the WBC and Plt were（7.3±5.4）×109L-1 and（113.5±56.7）×109L-1, respectively, which were higher than preoperative（P0.05）. The overall incidence of postoperative complications of 38 cases was 34.2%. 34 cases were successful completion of the follow- up, the follow- up completion rate was 94.4%. Follow up period were 9 to 58 months, with a median follow- up was 25 months. There was no bleeding again during follow- up, the overall survival rate was92.1%. Conclusion： Selective paraesophagogastric devascularization without splenectomy for treatment of patients with liver dysfunction and portal hypertension with upper gastrointestinal hemorrhage had a better short- term and long- term hemostatic effect. It had little effect on the liver and reduced the incidence of postoperative complications.