肝硬化食管胃底静脉曲张出血风险和手术择取相关性临床研究.docVIP

肝硬化食管胃底静脉曲张出血风险和手术择取相关性临床研究 　　【摘要】 目的：探讨临床肝硬化食管胃底静脉曲张出血风险与手术择取方式相关性。方法：选择本科肝硬化食管胃底静脉曲张出血患者151例，分别行经颈静脉肝内门腔静脉分流术52例、内镜下套扎术48例，选择性贲门周围血管断离术51例，观察比较三组患者术前、术后1个月、3个月门静脉压力测定值，记录随访患者再出血、治疗后再出血时间以及住院费用等情况。结果：治疗后三组患者在门脉压力改善方面，外科手术组明显优于其他两组，比较差异有统计学意义（P0.05），且外科手术组再出血率以及第二次出血时间亦显著优于其他两组（P0.05）。结论：单纯分流术与内镜下对肝硬化食管胃底静脉曲张患者的治疗效果并不明显，且无法很好的控制患者再出血的情况。选择性贲门周围血管断离术能够从根本上改善患者门静脉压过高的情况，值得在临床上推广应用。 　　【关键词】 肝硬化食管胃底静脉曲张； 出血风险； 手术择取方式； 分流术； 套扎术； 栓塞术 　　【Abstract】 Objective： To investigate the risk of bleeding esophageal varices and clinical studies related surgical options of Cirrhosis. Method： To choose subjects bleeding esophageal varices in 151 patients with cirrhosis， respectively transjugular shunt 52 cases of intrahepatic portal chamber， endoscopic band ligation 48 cases， selective cardia from around 51 cases of vascular surgery off， observe and compare three groups preoperative and postoperative January， March portal venous pressure measurements recorded follow-up of patients re-bleeding， bleeding after treatment and hospitalization expenses. Result： After the treatment of three patients of improvement inportal pressure， surgical operation group was significantly better than the other two groups， the difference was statistically significant （P0.05）. And the surgical operation group the rate of rebleeding and second bleeding time was significantly better than the other two groups， which had significant difference （P0.05）. Conclusion： Simple shunt and endoscopic of cirrhosis with esophageal and gastric fundus varices in patients of the treatment effect is not obvious， and control patients are not well rebleeding cases. Selective pericardial devascularization around blood vessels can fundamentally improve the portal venous pressure in patients with high， worth in clinical application. 　　【Key words】 Cirrhosis and esophageal varices； Risk of bleeding； Surgical choose to take way； Bypass surgery； Ligation； Embolization 　　First-author’s address： Huadu Huzhong Hospital， Guangzhou 518