改进的贲门周围血管离断术的临床应用

CLINICAL APPLICATION OF IMPROVED EXTENSIVE ESOPHAGOAGASTRIC DEVASCULARIZATION

目的 总结改进的贲门周围血管离断术治疗门静脉高血压症并发上消化道大出血的疗效 ,并对本术式断流的理论基础、彻底性进行讨论。方法 1 997年 3月— 2 0 0 2年 1月行贲门周围血管离断加断根术 2 2例 ,全部为肝炎后肝硬化所致门脉高压症 ,都有上消化道出血病史 ;切脾前、切脾后和断流后分别测自由门静脉压 (FreePortalveinPressure,FPP) ,所测数据用F检验分析 ,两两比较用q检验。 结果 切脾前检测FPP为 (36 .45± 0 .90 )cmH2 O ;切脾后FPP为 (2 7.64± 0 .90 )cmH2 O ;断流后FPP为 (30 .64± 0 .98)cmH2 O。经F检验各组的FPP差异有高度显著性 (P <0 .0 1 ) ;经 q检验切脾前、后比较和切脾前与断流后比较FPP差异有高度显著性(P <0 .0 1 ) ;切脾后与断流后比较FPP轻度上升 (P >0 .0 5)。急诊和预防性手术止血率 1 0 0 % ,围手术期死亡、手术后 2个月出现门静脉血栓各 1例 ,发生率均为 4 .1 %。随访时间为 3～ 48个月 ,平均 32个月 ,出血复发率为 0。结论 改进的贲门周围血管离断术疗效满意 ,其优点 :①断流彻底 ;②手术操作简便易行 ;③比经典的离断术减流更多 ,切脾后与断流后FPP改变无显著差异 ;④手术创伤小 ,不破坏食管和胃的完整性 ;⑤手术后再出血率低 。

Objective To evaluate the effect of improved extensive esophagoagsdtric devascularization on upper GI bleeding due to portal hypertension and to discuss the theoretical base and completeness. Methods From March 1997 to January 2002,22 portal hypertensive patients were treated using improved extensive esopha-goagastric devascularization.All of them were of post hepatitis cirrhosis and with a medical history of upper GI bleeding .FPP was measured respectively during the operation and after lienectomy and disconnection.The measured data is analyzed with F test.The data of groups is analyzed with q test. Results Before lienectomy,free portal vein pressure(FPP) was (36.45±0.90)cm H 2O;after lienectoney,FPP was (27.64±0.90)cm H 2O; after disconnection,FPP was (30.64±0.98)cm H 2O. Through F test there are a very significant differences of FPP between the data of all groups(P<0.01).Through q test there are very significant difference of FPP between pre-and post-ienectomy(P<0.01),between pre-lienectomy and post-disconction(P<0.01).There is a slightly increase of FPP between post-lienectomy and post-disconnection(P>0.05).The bleeding control rate of emergency and precaution operation was 100%.One case died of postope-ratively of hepaticrenal failure and respiratory failure.There was one case with portal thrombosis.Incidence was both 4.1%.The follow-up time was 3～48 months with 32months an average time.Recurrent bleeding rate was 0. Conclusions The method of operation is active and effective. The advantages are:①Completet and thorough portal-azygous disconnection;②Uncomplicated operation;③More reduced blood stream of portal vein than with traditional methods,and no significant difference of FPP between post-lienectomy and post-disconection;④Little operative trauma and with no damage to the integrality of esophagus and stomach.⑤Less recurrent bleeding rate and the satisfactory effect.