横断贲门的改良Sugiura术在复发性门静脉高压症合并上消化道大出血治疗中的应用

Application of Modified Sugiura Procedure with Cardia Transection in Treatment of Recurrent Portal Hypertension with Upper Gastrointestinal Bleeding

目的评价横断贲门的改良Sugiura术治疗复发性门静脉高压症合并上消化道大出血的临床效果。方法回顾性分析2007年1月至2015年1月期间宜昌市第二人民医院普外科和湖北省秭归县人民医院普外科收治的行横断贲门的改良Sugiura术的28例复发性门静脉高压症合并上消化道大出血患者的临床资料，总结其治疗效果。结果所有患者的手术均获成功，无手术死亡病例。手术时间120～300min，平均160min；术中出血量100～500mL，平均210mL。术后发生再出血2例，胃瘫6例，无食管贲门吻合口狭窄、吻合口漏、门静脉血栓形成等并发症发生。术后发生肝功能衰竭、肝昏迷致死亡3例。术后24例患者获访，随访时间为6～60个月，中位数为33个月，随访期间获访病例未再发生消化道出血。术后6个月时有16例行胃镜检查示静脉曲张根除效果较好，食管下段静脉曲张程度分级为GⅠ级14例，GⅡ级2例；内镜下静脉曲张形态为F1级11例，F2级5例。结论横断贲门的改良Sugiura术是治疗复发性门静脉高压症较彻底和安全的断流术。

Objective To evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding. Methods From January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People＇s Hospital of Yichang and The Zigui County People＇s Hospital, collecting the clinical data of them and then summarizing the therapeutic effect. Results All cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade G Ⅱ. For shape of varicose veins, there were 11 cases of grade F 1 and 5 cases of grade F2. Conclusion The modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.