应用吻合器经腹治疗门静脉高压食管胃底静脉曲张出血疗效分析

Transabdominal gastroesophageal stapling in the management of variceal bleeding in portal hypertension

目的 探讨应用吻合器经腹行食管下段部分切除再吻合治疗门静脉高压食管胃底静脉曲张出血的疗效。方法 回顾分析了自 1995年 10月至 2 0 0 1年 11月行贲门周围血管离断术加用吻合器作食管下段部分切除再吻合 4 8例 (切除组 )的疗效 ,并与 2 0例同期仅行周围血管离断术 (单纯组 )的疗效进行比较 ,分别观察食管曲张的消除率、再出血率、手术死亡率、吻合口狭窄以及吻合口瘘的发生率。结果 平均随访 2 0个月 ,单纯组再出血率为 2 5 % (5 / 2 0 ) ,切除组无再发出血。食管静脉曲张的治愈率切除组为 10 0 % ,而单纯组为 5 0 0 % (10 / 2 0 )。吻合狭窄发生率切除组为 4 1% (2 / 4 8) ,单纯组为 0。两组均未发生吻合口瘘。结论 应用吻合器行食管下段切除再吻合术是安全的 ,可使断离更为彻底 ,降低复发 ,从而进一步提高周围血管离断术的疗效。

Objective To investigate the therapeutic effect of gastroesophageal stapling on upper GI bleeding due to portal hypertension. Methods From Oct 1995 to Nov 2001,48 portal hypertensive patients were treated with pericardial devascularization plus partial resection of lower part of the esophagus with staple.The eliminating rate of varicose veins of the lower part of the esophagus and the stenosis rate of anastomosis were evaluated.Twenty patients with upper GI bleeding due to portal hypertension who received only pericardial devascularizatoin were taken as controls.Results All the patients were followed up for a mean time of 20 months.No patient in the study group had upper GI rebleeding during the 20 months follow-up.The rebleeding rate in the control group was 25%(5/20)( P <0.05,vs study group).The cure rate of varicose veins was 100% in the study group and 50.0%(10/20) in the control group ( P <0.01);the stenosis rate of anastomosis was 4.1%(2/48)in the study group and 0 in the control group.Conclusion The therapeutic effect of pericardial devascularization could be improved by using staple.