保留迷走神经选择性断流术加脾大部切除治疗门静脉高压症的疗效分析

Vagus nerve preserving pericardial devascularization with subtotal splenectomy for the treatment of portal hypertension

目的探讨保留迷走神经选择性贲门周围血管离断术联合脾大部切除治疗肝硬化门静脉高压症上消化道出血的临床疗效。方法对2004年4月至2013年12月于都县人民医院普外科33例行保留迷走神经选择性贲门周围血管离断术联合脾大部切除治疗肝硬化门静脉高压症上消化道出血（治疗组）的临床资料进行回顾性分析，并与同期34例行贲门周围血管离断术加全脾切除的病例（对照组）进行对照研究。结果两组均无围手术期死亡。治疗组72h胃液总引流量为（1525±30）ml，对照组为（2130±40）ml，两组相比差异有统计学意义，P〈0．05；治疗组术后并发门静脉血栓1例，对照组为15例，两组相比差异有统计学意义，P〈0．05；治疗组发生腹水3例，对照组8例，两组相比差异有统计学意义，P〈0．05；3个月后，治疗组体重增加8例，对照组3例，两组相比差异有统计学意义，P〈0．05；治疗组术后3年上消化道出血复发率为15％，对照组为25％，两组相比差异有统计学意义，P〈0．05：治疗组的5年上消化道出血率为28％，对照组为30％，两组相比差异无统计学意义，P〉0．05：两组的5年生存率相比差异无统计学意义，P〉0．05。结论保留迷走神经选择性贲门周围血管离断术联合脾大部切除治疗肝硬化门静脉高压症上消化道出血术后近期并发症少、门静脉血栓发生率低、患者的生存质量好。

Objective To investigate the clinical effect of vagus nerve preserving pericardial devascularization plus subtotal splenectomy in treating portal hypertension with a history of variceal bleeding. Methods The clinical data of 33 cases of portal hypertension with variceal hemorrhage treated with vagus nerve preserving selective pericardial devascularization plus subtotal splenectomy from April 2004 to December 2013 （ study group） were compared with that of 34 cases treated with pericardial devascularization plus splenectomy （control group ）. Results There was no mortality in two groups. The postoperative gastric drainage during the first 72 h were（ 1 525 ±30） ml in the study group and （2 130 ±40） ml in control group（P〈0.05）. Portal vein thrombosis developed in one case in the study group and 15 cases in the control group（ P 〈 0.05 ）. Postoperative 3-year recurrent gastroesophageal varices hemorrhage was 15% in the study group and 25% in the control group （ P 〈 0. 05 ）. Postoperative 5-year variceal hemorrhage recurrence rate were 28% in the study group and 30% in the control group （P 〉 0.05 ）. Conclusions Maitaining vagus nerve selective pericardial devascularization plus subtotal splenectomy is of less postoperative complication and lower portal vein thrombosis rate and better patients＇ survival compared with pericardial devascularizatim plus total splenectomy.