脾腔分流联合断流术治疗门脉高压症上消化道出血疗效观察.docVIP

脾腔分流联合断流术治疗门脉高压症上消化道出血疗效观察[摘要] 目的 总结脾腔分流联合断流术治疗门脉高压症上消化道出血的疗效及经验。方法 对38例门脉高压症上消化道出血患者行脾腔静脉端侧吻合联合贲门周围血管离断术治疗。结果 38例患者手术顺利完成并好转出院，无手术死亡病例，术后近期无出血，术后随访1~5年，平均4.2年，再出血1例（2.6%），无肝性脑病发生，5年生存率为97.4%。结论 脾腔分流联合断流术治疗门脉高压症上消化道出血疗效肯定，是一种合理、可靠、安全的手术方式。 [关键词] 门脉高压症；上消化道出血；脾腔分流术；贲门周围血管离断术 [中图分类号] R657.34 [文献标识码] B [文章编号] 1673-9701（2011）35-134-02 Curative Effect Observation on the Treatment of Portal Hypertension and Upper Gastrointestinal Bleeding by Splenic Shunt Combined with Devascularization ZHOU Ren Department of Hepatobiliary Surgery, the First People’s Hospital of Yulin City, Yulin 537000, China [Abstract] Objective To summarize curative effect and experiences of treatment of portal hypertension and upper gastrointestinal bleeding by splenic shunt combined with devascularization. Methods All 38 cases of patients with portal hypertension and upper gastrointestinal bleeding were cured by side and end anastomosis of splenic intravenous combined with amputation surgery of pericardial vascular. Results Surgery of 38 patients were successful and recovery. There were no operative deaths and no postoperative bleeding. Patients were followed up 1 to 5 years (average of 4.2 years ) and 1 case of re-bleeding was found (2.6%). There were no hepatic encephalopathy and 5-year survival rate was 97.4%. Conclusion Splenic shunt combined with devascularization for the treatment of portal hypertension and upper gastrointestinal bleeding has a positive effect. The method was a reasonable, reliable and safe surgical procedure. [Key words] Portal Hypertension; Upper Gastrointestinal Bleeding; Splenic Shunt; Amputation surgery of pericardial vascular 门脉高压并发食管胃底静脉曲张是导致上消化道出血的主要原因，外科治疗的主要目的是预防和治疗上消化道出血，我院于2004年1月~2009年12月对38例门脉高压症上消化道出血患者施行脾腔分流联合断流术治疗，取得满意效果，现报道如下。 1 临床资料 1.1 一般资料 本组38例中男21例，女17例，年龄28~77岁，平均46.5岁，均为乙型肝炎后肝硬化患者。既往有上消化道出血1~3次者20例，首次出血18例。所有患者在术前均进行过数次胃镜和肝功能检查，全部有中度以上的食管胃底静脉曲张。根据Child-pugh肝功能分级标准[1]：A级7例，B级27例，C级4例。急诊手术11例，择期手术27例。急诊手术术前均经补充血容量、输血纠正休克及护