断流术治疗门静脉高压症上消化道出血236例分析

Effect of esophagogastric devascularization with splenectomy on 236 upper gastrointestinal bleeding due to portal hypertension

目的 总结脾切除贲门周围血管离断术治疗门静脉高压症合并上消化道大出血的疗效。方法 对不合并肝癌及胆管癌的门静脉高压症合并上消化道出血患者行脾切除贲门周围血管离断术并随访 2 3 6例 ,其中肝炎后肝硬化 2 17例 ,占91 9% (2 17/2 3 6)。结果 围手术期止血率 98 3 % (2 3 2 /2 3 6) ,围手术期死亡率 1 2 7% (3 /2 3 6) ,主要死亡原因是上消化道出血、肝功能衰竭。平均随访时间 2 3年 ,术后复发出血率 3 3 7% (8/2 3 6) ,肝性脑病发生率 2 97% (7/2 3 6)。结论 脾切除贲门周围血管离断术治疗门静脉高压症引起的上消化道出血效果好。为提高手术疗效应做到 :合理掌握手术适应证及手术时机 ,彻底断流 ,熟练掌握本手术的技术要点 。

Objective To evaluate the effect of esophagogastric devascularization with splenectomy on upper gastrointestinal (GI) bleeding due to portal hypertension without hepatocellular carcinoma or bile duct cancer. Methods A total of 236 pertal hypertensive patients were followed-up and treated using esophagogastric devascularization with splenectomy. Results The bleeding control rate of surgical operation was 98 3%. Perioperative mortality rate was 1 27%(3/236). The major death causes were recurrent upper GI bleeding and hepatic-renal failure. The mean follow-up time was 2 3 years. Recurrent bleeding rate was 3 37%(8/236). The hepatic encephalopathy rate was 2 97%(7/236). Conclusion The esophagogastric devascularization with splenectomy appears to be effective for the control of variceal hemorrhage due to portal hypertension. To improve the operated result, the following should be emphasized: the selection of the operative opportunity and indications, the importance of whole and thorough porta-azygous disconnection and the performance of the operation in according to the corrective technique, prevention of surgical complications.