改良Sugiura手术治疗门静脉高压症的回顾

Experience of modified Sugiura procedure treating for portal hypertension in ten years more

目的 总结 11年零 5个月采用改良Sugiura手术治疗门静脉高压症的经验 ,评价改良Sugiura手术的优劣。方法 回顾分析 1991年 1月至 2 0 0 2年 6月 ,对 15 4例肝硬化性门静脉高压症施行改良Sug iura手术治疗的结果。结果 手术死亡率为零 ,腹腔内继发性出血 2例 (1.30 % ) ,肺不张和肺部感染各 1例(0 .6 5 % ) ,脾静脉血栓 4例 (2 .6 0 % )。术后随访率 99.35 % (15 3 15 4 ) ,随访时间 5个月 - 11年零 5个月。绝对生存率 98.70 % (15 2 15 4 ) ;肝性脑病发生率 0 .6 5 % (1 15 4 ) ;再出血率 1.95 % (3 15 4 ) ;83例于手术半年后接受过胃镜或食道吞钡检查 ,食管胃底曲张静脉消失者 5 4例 (6 5 .0 6 % ) ,显著改善者 2 8例 (33.74 % ) ,无变化者 1例 (1.2 0 % ) ;6 2例胃镜检查发现有不同程度门脉高压性胃病者 8例 (12 .90 % )。结论 改良Sugiura手术治疗肝硬化性门静脉高压症的疗效优良 ,其再出血率和肝性脑病发生率均很低 ,并发症少 ,手术操作较简单 。

Objective To summarize the experience of treating patients suffering from portal hypertension with modified Sugiura procedure and to evaluate the effect in 11 years and 5 months. Methods The results of modified Sugiura procedure performed in 154 patients with portal hypertension secondary to liver cirrhosis were analyzed from January 1991 to June 2002. Results The operative mortality was zero. 2 cases developed secondary intra-abdominal bleeding, 1 drowned lung, 1 pneumonia, and 4 splenic venous thrombosis. One hundred and fifty three out of 154(99.35%) were followed-up, the follow-up period ranged from 5 months to 11 years and 5 months. The incidence rate of hepatic coma and rebleeding rate was 0.65%(1/154) and 1.95%(3/154) respectively. In 91 out of 102(89.22%) patients, liver functions changed better from Child-Pugh grade B to A at first to third month after operation. In 83 patients accepted gastroscopy (62 cases) or esophageal barium photography (21 cases) six months later after operation, the gastro-esophageal varices disappeared rate in 54 patients, obviously improved in 28 patients, no change of esophageal varices took place only in one patient; the morbidity of portal hypertensive gastropathy (PHG) was 12.90%(8/62). Conclusions The effect of modified Sugiura procedure is very satisfactory and the rate of complication, rebleeding, and hepatic coma is low.