Objective: To evaluate the significance of intraopera- tive reassessment of liver function reserve in the se- lection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension. Met...Objective: To evaluate the significance of intraopera- tive reassessment of liver function reserve in the se- lection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension. Methods: The data of 146 patients with portal hyper- tension treated in the past 10 years were retrospec- tively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other disea- ses in 16. According to Child's criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61. 0%) and shunt procedure in 57 (39. 0 %). These opera- tions included prophylactic operations in 27 patients (18. 5 %) and emergency disconnection operations in 2 (1. 4%). Results: One patient (0. 7 %) died of upper gastroin- testinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6. 1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy after operation occurred in 2 patients (1. 4 %) (disconnection in 1 patient and shunt in 1). A total of 98 patients (67. 6%) (disconnection in 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12. 2 %) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late re- bleeding rates of shunt patients and disconnection pa- tients were 8.1% (3/37 patients) and 14. 9 % (9/ 61) (P>0. 05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16. 2% (6/37) and 0% (0/61) respectively (P <0. 01). Eight patients (5. 5 %) died of upper gas- trointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up. Conclusions: The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient's liver function reserve. In- tra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient's hepatic function reserve, local anatomical conditions and surgeon's experience would optimize therapeutic results.展开更多
Objective： To investigate the clinical effect of fast-track surgery combined with Chinese medicine treatment in devascularization operation for cirrhotic esophageal varices. Methods： Seventy-two patients with cirrho...Objective： To investigate the clinical effect of fast-track surgery combined with Chinese medicine treatment in devascularization operation for cirrhotic esophageal varices. Methods： Seventy-two patients with cirrhotic esophageal varices were selected from January 2009 to June 2013, and randomly assigned to a conventional group and a fast-track group （fast-track surgery combined with Chinese medicine treatment） using a randomized digital table, 36 cases in each group. Operation and anesthesia recovery time, postoperative hospitalization and quality of life were recorded and compared between groups during the perioperative period. Results： Compared with the conventional group, the fast-track group had longer operation time （253.6±46.4 min vs. 220.6±51.0 min） and anesthesia recovery time （50.5 ± 15.9 rain vs. 23.5± 9.6 min; P〈0.01）; less bleeding （311.3±46.8 mL vs. 356.2 ± 57.5 mL; P〈0.01） and less transfusion （1932.3 ± 106.9 mL vs. 2045.6 ± 115.4 mL; P〈0.01）; as well as faster recovery of gastrointestinal function, shorter postoperative hospitalization and higher quality of life. There were no serious postoperative complications and no further bleeding occurred. Conclusion： Fast-track surgery combined with Chinese medicine treatment is a safe and feasible approach to accelerate the recovery of patients with cirrhotic portal hypertension in perioperative period of devascularization operation.展开更多
文摘Objective: To evaluate the significance of intraopera- tive reassessment of liver function reserve in the se- lection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension. Methods: The data of 146 patients with portal hyper- tension treated in the past 10 years were retrospec- tively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other disea- ses in 16. According to Child's criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61. 0%) and shunt procedure in 57 (39. 0 %). These opera- tions included prophylactic operations in 27 patients (18. 5 %) and emergency disconnection operations in 2 (1. 4%). Results: One patient (0. 7 %) died of upper gastroin- testinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6. 1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy after operation occurred in 2 patients (1. 4 %) (disconnection in 1 patient and shunt in 1). A total of 98 patients (67. 6%) (disconnection in 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12. 2 %) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late re- bleeding rates of shunt patients and disconnection pa- tients were 8.1% (3/37 patients) and 14. 9 % (9/ 61) (P>0. 05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16. 2% (6/37) and 0% (0/61) respectively (P <0. 01). Eight patients (5. 5 %) died of upper gas- trointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up. Conclusions: The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient's liver function reserve. In- tra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient's hepatic function reserve, local anatomical conditions and surgeon's experience would optimize therapeutic results.
文摘Objective： To investigate the clinical effect of fast-track surgery combined with Chinese medicine treatment in devascularization operation for cirrhotic esophageal varices. Methods： Seventy-two patients with cirrhotic esophageal varices were selected from January 2009 to June 2013, and randomly assigned to a conventional group and a fast-track group （fast-track surgery combined with Chinese medicine treatment） using a randomized digital table, 36 cases in each group. Operation and anesthesia recovery time, postoperative hospitalization and quality of life were recorded and compared between groups during the perioperative period. Results： Compared with the conventional group, the fast-track group had longer operation time （253.6±46.4 min vs. 220.6±51.0 min） and anesthesia recovery time （50.5 ± 15.9 rain vs. 23.5± 9.6 min; P〈0.01）; less bleeding （311.3±46.8 mL vs. 356.2 ± 57.5 mL; P〈0.01） and less transfusion （1932.3 ± 106.9 mL vs. 2045.6 ± 115.4 mL; P〈0.01）; as well as faster recovery of gastrointestinal function, shorter postoperative hospitalization and higher quality of life. There were no serious postoperative complications and no further bleeding occurred. Conclusion： Fast-track surgery combined with Chinese medicine treatment is a safe and feasible approach to accelerate the recovery of patients with cirrhotic portal hypertension in perioperative period of devascularization operation.
