选择性断流术治疗门静脉高压症的临床研究.docVIP

选择性断流术治疗门静脉高压症的临床研究 【摘要】 目的 研究选择性断流术对门静脉高压症临床疗效及转归的影响。方法 回顾性分析1994年1月至2006年12月收治的门静脉高压症患者187例的临床资料，分为保留食管旁静脉组(选择组)154例和未保留食管旁静脉组(传统组)33例。通过对临床疗效的观察、术中自由门静脉压(FPP)的动态监测、术后肝功能变化的检测以及术后近期并发症的发生情况进行对比研究。结果 术后两组患者FPP均下降，与术前比较差异有统计学意义(P＜0.01)，且选择组FPP降幅大于传统组(P＜0.01)；术后选择组近期并发症总发生率和死亡率均明显低于传统组(P＜0.01)；术后1周选择组天冬氨酸氨基转移酶(AST)明显降低，与术前比较差异有统计学意义(P＜0.01)，其余肝功能指标与术前比较差异无统计学意义(P＞0.05)。结论 选择性断流术能更有效地降低门静脉压力，确切控制食管及胃底部曲张静脉破裂出血，降低术后近期并发症的发生率，并有利于肝脏功能的恢复。 【关键词】 门静脉 高血压 断流术 食管旁静脉 自由门静脉压 Modified devascularization in the management of portal hypertension Abstract:ObjectiveTo investigate the influence of compensatory dilated paraesophageal vessels reserved on free portal pressure(FPP),liver function and early complications in patients with portal hypertension.MethodsThe clinical data of 187 patients with portal hypertension underwent operations in our hospital from January 1994 to December 2006 were retrospectively analyzed.All the patients were divided into two groups according to the paraesophageal vessels having been reserved(154 cases,selective group)or not(33 cases,traditional group).Pre and postoperative differences in FPP and liver function between the two groups were studied as well as postoperative complications.ResultsFPP decreased obviously after devascularization in both groups(P＜0.01),the decrease amplitude of FPP was significantly higher in selective group than that in traditional group(P＜0.01).Postoperative complications and death rate were lower in selective group than those in traditional group(P＜0.01).Liver function was slightly influenced in both groups,and aspartate transaminase(AST) ameliorated significantly in selective group(P＜0.01).ConclusionIt is the devascularization with paraesophageal vessels reserved that decreases FPP more effectively,down regulates incidence of total postoperative complications and is beneficial to liver function. Key words:portal hypertension; devascularization; paraesophageal vessels; free