肝硬化门静脉高压症门奇断流术前内镜下曲张静脉套扎对预防再出血的临床疗效

Clinical effect of endoscopic variceal ligation before surgery in preventing rebleeding in cirrhosis portal hypertension

目的观察肝硬化门静脉高压症门奇断流前行食管曲张静脉套扎对预防术后胃底食管曲张静脉再出血的临床疗效。方法采用回顾性研究方法,收集2014年1月至2018年1月陆军军医大学第二附属医院收治的78例肝硬化门静脉高压症并行外科手术治疗患者的临床病理资料。根据术前是否行内镜下食管曲张静脉套扎(EVL)手术分为常规门奇断流组(门奇断流组)36例和EVL+门奇断流组42例。观察并比较两组患者术后胃底食管曲张静脉再出血、手术并发症、术中出血量,并进行定期随访,随访时间截至2020年1月。结果门奇断流组术后6个月内胃底食管曲张静脉再出血3例,术后6~24个月内再出血8例。EVL+门奇断流组术后6个月内胃底食管曲张静脉再出血1例,术后6~24个月内再出血2例。两组术后6~24个月内胃底食管曲张静脉再出血发生率比较差异有统计学意义(P<0.05)。门奇断流组患者出现胃排空延迟4例,胸腔积液5例,腹腔内出血2例,胰漏4例。EVL+门奇断流组患者出现胃排空延迟7例,胸腔积液6例,腹腔内出血3例,胰漏3例。两组均无围术期死亡患者;两组术后并发症发生率比较差异无统计学意义(P>0.05)。门奇断流组术中出血量为(250±15)mL,EVL+门奇断流组术中出血量为(240±10)mL(P>0.05)。结论肝硬化门静脉高压症门奇断流前行EVL可预防术后胃底食管曲张静脉再出血,不增加手术并发症发生率。

Objective To observe the clinical effect of esophageal variceal ligation before surgery in preventing rebleeding in cirrhosis portal hypertension.Methods The clinicopathological data of 78 patients with portal hypertension due to cirrhosis who underwent surgical therapy in Xinqiao Hospital of Chongqing from January 2014 to January 2018 were retrospective analyzed.According to whether endoscopic esophageal variceal ligation(EVL)was performed before surgery,the patients were divided into the routine devascularization group(36 cases)and the preoperative EVL+devascularization group(42 cases).Postoperative rebleeding,surgical complications and intraoperative blood loss were observed and compared between the two groups,and regular follow-up was conducted until January 2020.Results A total of three patients showed postoperative rebleeding within six months after operation in the routine devascularization group and 8 cases of hemorrhage within 6-24 months after operation.There were four cases within six months after operation and two cases within 6-24 months after operation in the preoperative EVL+devascularization group.There was statistically significant difference in the incidence of rebleeding between the two groups within 6-24 months after surgery(P<0.05).In the routine devascularization group,there were four cases with delayed gastric emptying,five cases with pleural effusion,two cases with intraperitoneal hemorrhage and four cases with pancreatic leakage.There were seven cases of delayed gastric emptying,six cases of pleural effusion,three cases of intra-abdominal hemorrhage and three cases of pancreatic leakage in the preoperative EVL+devascularization group.There were no perioperative deaths.There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The intraoperative blood loss was(250±15)mL in the routine devascularization group,and(240±20)mL in the preoperative EVL+devascularization group(P>0.05).Conclusion Endoscopic variceal ligation before surgery in cirrhosis portal hypertension can prevent postoperative rebleeding,without increasing the incidence of surgical complications.