贲门周围血管离断加胃底血管横断术应用于晚期血吸虫病效果

Application effect of pericardial devascularization plus gastric fundus transaction in advanced schistosomiasis

目的探讨贲门周围血管离断术加胃底血管横断术应用于晚期血吸虫病(晚血)门静脉高压症患者的效果。方法选择阳新县第三人民医院自2006年以来实施贲门周围血管离断加胃底血管横断术的36例晚血患者(胃底血管横断组),以及同期采用改良Sugiura术进行治疗的10例晚血患者(改良Sugiura组)作为观察对象,比较两类患者的临床疗效。结果胃底血管横断组患者手术时间、胃管留置时间、术后进食时间、引流管拔除时间均短于改良Sugiura组,差异均有统计学意义(P均<0.05),两组住院费用分别为(25 466.00±2 888.48)元和(34 517.10±4 948.39)元,差异亦有统计学意义(P<0.05)。术后胃底血管横断组和改良Sugiura组门静脉血栓发生率分别为33.33%(12/36)和40.00%(4/10),两组术后12个月再出血发生率分别为16.67%(6/36)和10.00%(1/10),差异均无统计学意义(P均>0.05);改良Sugiura组出现1例胃排空障碍和1例食管吻合口漏,胃底血管横断组无相应并发症发生。结论贲门周围血管离断加胃底血管横断术操作相对简单,近期临床效果较好,适用于基层医院,但其远期效果还有待进一步观察。

Objective To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schis？tosomiasis patients with portal hypertension. Methods Thirty？six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction（a portal hypertension group）,as well as 10 patients treated with modified Sugiura operation（a modified Sugiura operation group）in the Third People’s Hospital of Yangxin County since 2006 were chosen as the observation objects,and the clinical effects of the two groups were observed and compared. Results The op？eration time,indwelling time of stomach tube,time to taking food after operation,drainage tube removal time of the portal hy？pertension group were all shorten than those of the modified Sugiura operation group（all P〈0.05）. The hospitalization expenses of the two groups were（25 466.00 ± 2 888.48）Yuan and（34 517.10 ± 4 948.39）Yuan respectively,and the difference was al？so statistically significant（P〈0.05）. The incidence rates of portal thrombosis of the portal hypertension group and modified Sug？iura operation group were 33.33%（12/36）and 40.00%（4/10）,respectively,and the incidence rates of rehaemorrhagia of the two groups 12 months after the operation were 16.67%（6/36）and 10.00%（1/10）,respectively,but the differences had no sta？tistically significance（both P〉0.05）. In addition,1 case with delayed gastric emptying and 1 case with stomal leak of esopha？gus happened in the modified Sugiura operation group,while no corresponding complications happened in the portal hyperten？sion group. Conclusions Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short？term clinical effect,and therefore it is suitable for application in primary hospitals. However,its long？term effect still needs fur？ther observation.