保留迷走神经主干的门奇断流术治疗门静脉高压症32例报告

Vagus-Preserving Porto-azygous Devascularization.

目的 :探讨保留迷走神经主干门奇断流术 (VPPD )的手术方法及治疗效果。方法 :通过尸体解剖 ,了解食管下端迷走神经前后主干走行 ,设计出该术式的游离曲线 ,在临床上应用 32例 ,并与同期施行的、资料比较完整的门奇断流术 (PD) 32例和门奇断流术加幽门成形术 (PD加PP) 1 6例进行比较。结果 :手术死亡率和术后再出血率VP PD组分别为 3 .1 %和 6 .3 % ,PD组分别为 6 .3 %和 9.4% ,PD加PP组均为 6 .3 % ,3组无明显差异 (P >0 .0 5)。胃肠功能恢复时间VPPD组平均 3 .5d ,较PD组平均 5 .7d和PD加PP组平均 4 .2d明显快 (P <0 .0 2 )。食后饱胀率和肠胃反流发生率在VPPD组均为 6 .3 % ,PD组分别为 46 .9%和 1 8.8% ,PD加PP组分别为 1 2 .5 %和 1 0 0 % ,3组有极显著性差异 (P <0 .0 0 5)。胃液滞留、突发性腹泻和远期胆囊结石发生率PD组分别为 2 5 %、1 5 .6 %和7.1 % ,PD加PP组分别为 1 2 .5 %、1 8.8%和 6 .3 % ,而VPPD组无一例发生。结论 :VPPD能较好地维持胃的正常动力学及肝胆、肠道系统的生理功能 ,最大限度地减少术后并发症的发生 ,疗效优于PD和PD加PP。

To study the operative procedure and therapeutic effects of vagus preserving porto azygous devascularization(VPPD). Methods: Studying of the course of the vagal trunks by autopsy was made prior to designing the operative procedure of the VPPD. The procedure was performed in 32 cases, in comparison to 32 cases of simple porto azygous devascularization(PD) and 16 cases of porto azygous devascularization with pyloroplasty(PD+PP). Results: The operative mortality and the recurrence of postoperative bleeding rate were 3.1% and 6.3% in the VPPD group, 6.3% and 9.4% in the PD group and 6.3% and 6.3% in the PD+PP group respectively(P>0.05). Time of GI function recovery averaged 3.5 d in the VPPD group, and 5.7 d and 4.2 d respectively in the PD and PD+PP groups, there was significant difference among the 3 groups(P<0.02). The incidences of postprandial satiety and enterogastric reflux were all 6.3% in the VPPD group, 46.9% and 18.8% in the PD group and 12.5% and 100% in the PD+PP group respectively, there was significant difference among the groups(P<0.005). The incidence of the gastric juice retention, abrupt diarrhea and the late formation of gallbladder stone were 25%, 15.6% and 7.1% in the PD group and 12.5%, 18.8% and 6.3% in the PD+PP group respectively, but not in VPPD group. Conclusions: Because vagus trunks were retained in the VPPD group, normal gastric dynamics and function of the hepato biliary and intestinal systems were better maintained.