分断联合术与断流术治疗食管曲张静脉破裂出血的对比

Comparative study of effects of combined procedure and portaazygous devascularization on esophageal variceal bleeding

目的 对比观察分断联合术 (脾肾分流加贲门周围血管离断术 )治疗食管曲张静脉破裂出血 (EVB)的效果 .方法 回顾总结 1978/ 2 0 0 0入院的 2 2 0例 EVB患者随机分为两组 ,分别施行分断联合术 (n=12 0 )和断流术 (n=10 0 ) ,通过疗效观察和对其中部分患者采用彩色多普勒显像 (DCFI)、数字减影血管造影 (DSA)和术中自由门静脉压 (FPP)动态测量 ,观察手术前后门静脉血流动力学变化的对比研究 .结果 分断联合术后近期无出血 ,再出血率为 8.9% ,术后肝性脑病为 5 .1% ,术后 5 ,10和 15 a生存率分别为 83.4 % ,6 4 .5 %和 5 4 .5 % .其术后近期出血率、远期再出血率、肝性脑病发生率和临床疗效均好于断流组 .分断联合术后 FPP和 PVF降低有显著意义 (P<0 .0 1) .结论 分断联合术保留了断流和分流术二者的优点 ,又克服了二者的缺点 ,具有止血效果确切 ,再出血率低 ,肝性脑病发生率低等优点 。

AIM To compare retrospectively the effects of combined operation (splenorenal shunt plus portaazygous devascularization) and pericardial devascularization only (PCDV) on esophageal variceal bleeding (EVB). METHODS We summarized 220 cases of EVB admitted from april 1978 to april 2000. All patients were divided into combined operative group (140 patients) and PCDV group (100 patients). The therapeutic effects and changes of portal hemodynamics were studied with doppler flowmeter and DSA pre and postoperatively, and FPP were measured directly during the course of procedure. RESULTS Of all the patients who underwent combined operation, no rebleeding occurred in a short period after the operation, and the rebleeding rate was 8.9% in a long period follw up. The rate of hepatic encephalopathy was 5.1% postoperatively, and the long term surrival rate of 5 , 10 and, 15 year period of time were 83.4% , 64.5%, and 54.5%, respectively. Considering the rebleeding rate of short term and long term and the hepatic encephalopathy occurrence rate, the combined operation had much more advantages than PCDV only. There was a significant decrease of FPP and PVF postoperatively ( P < 0.01 ). CONCLUSION The combined procedure has merits on stopping hemorrhage with lower rates of rebleeding and hepatic encephalopathy. It is a rational and practical procedure in patients with esophageal variceal bleeding.