青木春夫式断流术180例临床报告

Results of Aoki's disconnective operation in 180 cases

目的评价青木春夫式断流术的疗效。方法回顾性分析1980年1月～1996年6月施行青木春夫式断流术180例。结果手术死亡率1.66%(3/180),术后远期出血23例(12.99%),脑病4例(2.25%)。绝对生存率1年86.11%(155/180);3年78.21%(122/156);5年71.22%(99/139);10年58.43%(52/89)。结论再出血的原因与手术方式、病人状况、手术者水平有关。患者于术后1年内死亡与手术有关;术后1～5年的死亡多数与术后出血和脑病有关,并且超过术后出血总数2/3和脑病总数3/4;术后5年以上的死亡则与肝硬变程度及其进展有关。降低术后1年内死亡率的关键是注重围手术期处理,对术后1～5年的病人应定期检查食道胃底静脉,采取各种非手术的预防措施,减少再出血,降低死亡率。

Objective To evaluate the effectiveness of Aoki's procedure in the treatment of portal hypertension. Method From January 1980 to June 1996,we performed Aoki's disconnective operation in 180 cases.Result The operation mortality was 1.66%(3/180),the long-term rebleeding occurred in 23 cases(12.99%), encephalopathy developed in 4 cases(2.25%).The 1,3,5,10 year's absolute survival rate were 86.11% (155/180),78.21%(122/156),71.22%(99/139),and 58.43%(52/89)respectively.The causes of long- term rebleeding related to the operation mathods,condition of patients and perfectness of the operation.The mortality within 1 year has a close relationship with operation;The 1～5 year mortality mostly correlated to re- bleeding(over 2/3 of total rebleeding)and encephalopathy(over 3/4 of encephalopathy);The 5 year and up mortality were correspondent with the severity and deterioration of the liver function.Conclusion The operative maneuver and perioporative intensive therapy was the key in decreasing the 1 year mortality and complications. Patients should be regularly followed-up for their esophageal varices,liver functions,and a variety of nonopera- tive measures should be undertaken to improve the patients' general condition in order to lower the rebleeding rate and mortality.