改良Sugiura术后22例并发症临床研究.docVIP

改良Sugiura术后22例并发症临床研究【摘要】 目的 探讨联合断流术治疗门静脉高压症引起的食管下端胃底曲张静脉破裂出血的安全性和有效性。方法 对本院1997年1月至2008年10月治疗的150例门脉高压症并出血的病例进行回顾性总结分析。结果 22例患者出现术后并发症，术后并发症发生率为14.7%，5例患者出现术后发热，腹腔大出血和胃肠道功能紊乱分别出现6例和4例，胃坏死和食道损伤均为3例，门静脉血栓患者仅发现1例。结论 应用该术式后患者发生并发症少，死亡率低，远期疗效满意，是防治门静脉高压症引起的食管下端胃底曲张静脉破裂出血的理想术式。 【关键词】联合断流术；并发症；防治 The clinical analysis of 22 cases complication after united devascularization HUANG Zhi-geng,HUANG Huai-jian,et al.Municipal Hospital of Puning Huaqiao Hospital,Guangdong 515300,China 【Abstract】 Objective To investigate the safety,rationality and eficacy of the Combined esophagogastric devascularization in the treatment of esophagogastric variceal bleeding caused by portal hypertension.Methods The treatment of 150 patients who underwent the Combined esophagogastric devascularization between January 1997 and October 2008 were retrospectively analyzed．Results 22 cases were found post-operative complication.the total incidence of post-operative complication was 14.7%(22/150).5 cases were Postoperative fever.Abdominal hemorrhage and functional disturbances ofgastrointestinal tract were respectively 6 and 4 cases.esophageal injury and gastrivc necrosis all were 3 cases.portai vein thrombosis was only 1 cases.Conclusion The Combined esophagogastric devascularization is a rational surgical procedure in thetreatment of portal hype rtension． 【Key words】United devascularization;Complication;Combat 联合断流术(改良Sugiura术)是贲门周围血管离断术(Hassab术)与食管胃壁肌层和黏膜下层的血流阻断术的总称。采用的联合断流术，即经腹行脾切除并结扎切断胃短动脉、静脉，结扎胃冠状静脉以及胃支、食管支、高位食管支、胃后和左膈下静脉。游离食道约6~8 cm，在其下端吻合器横断并吻合，对预防和治疗食道静脉破裂出血效果肯定，已在国内外临床广泛采用。本组病例选择本院1997年1月至2008年10月，门脉高压症患者择期手术150例，就其手术并发症22例报告分析如下。 1 资料与方法 1.1 一般资料本组150例，男93例，女57例，年龄26~63岁，平均46岁。均有不同程度的上消化道出血史，术前经纤维胃镜或食管钡餐检查103例，胃镜均提示中度及重度食管胃底静脉曲张，脾大脾亢者85例，肝功能Child A级36例，B级84例，C级50例。肝炎相关抗体阳性者95例。肝炎后肝硬化92例，血吸虫性肝硬化24例，酒精性肝硬化25例，未明原因9例。所有手术均为择期手术。 1.2 手术方法 上腹正中切口或左上腹部肋缘下斜形切口,入腹后分离脾胃韧带，切除脾脏。如为巨脾可先分离结扎脾动脉，使脾脏缩小后再处理。然后按贲门周围血管离断术的方法分别离断胃短动静脉、胃冠状静脉、胃后静脉及左膈下静脉。重点在于离断胃冠状静脉及其分支，分离过程中应注意紧贴胃大小弯胃壁游离