选择性贲门周围血管离断术联合脾切除术治疗门静脉高压症的临床评价

The clinical assessment of selective devascularization for the treatment of portal hypertension

目的研究选择性断流术对门静脉高压症临床疗效的影响。方法回顾性分析88例选择性断流治疗门静脉高压症病例的临床资料。结果断流前、后自由门静脉压力显著下降,差异有统计学意义(P<0.05);手术后较术前血小板计数明显增长,差异有统计学意义(P<0.05);其中72例获得随访6~36个月,随访率为81.8%,围术期无手术死亡患者,3年内死亡9例,6例因复发出血死亡,3例死于肝癌,3年生存率71.9%,其中门静脉系统血栓12例(16.7%);肝性脑病4例(5.5%);上消化道再出血8例(11.1%),其中5例为食管胃底曲张出血,3例为门脉高压性胃病引起;再发食管胃底静脉曲张11例(15.3%),门静脉高压性胃病24例(33.3%)。结论:选择性断流术因其合理的保留了机体的自发性分流,有效的降低了自由门静脉压力,并降低了术后并发症,体现了这种手术方式在治疗门静脉高压症的合理性和优越性。

Objective To investigate the effect of selective disconnection on the chnical efficacy of portal hypertension. Methods Clinical data of 88 portal hypertension patients using selective devascularization were retrospectively analyzed. Results Selective cut-out before and after free portal pressure were dropped significantly（P 〈 0. 05）. After surgery platelets were increased sig- nificantly than before （P 〈 0. 05 ）. There were 72 cases followed up 6-36 months, follow-up rate of 81.8%, perioperative patients with- out surgical death,3 years of death in 9 cases ,6 cases died of recurrence bleeding, the other 3 cases died of liver cancer,3-year survival rate of 71.9%. There were 12 cases （ 16. 7% ） of portal vein thrombosis ,4 cases of hepatic encephalopathy （5.5%） ,8 cases of upper gastrointestinal rebleeding （ 11.1% ） ,5 cases of esophageal variceal bleeding,3 cases of portal hypertensive gastropathy （ 15.3% ） ,24 cases （33.3%） of portal hypertensive gastropathy. Conclusion： Selective disconnection is a reasonable way to keep the spontaneous shunt of the body, effectively reduce the free portal vein pressure and reduce the postoperative complications, which reflects the rationali- ty and superiority of this surgical approach in the treatment of portal hypertension.