| 余灵祥张绍庚郭晓东肖朝辉赵德希孙佳轶张培瑞李志伟△.2200 例门静脉高压症患者行脾切除贲门周围血管离断术
的近期疗效观察*[J].,2014,14(10):1883-1885 |
| 2200 例门静脉高压症患者行脾切除贲门周围血管离断术
的近期疗效观察* |
| Short-termEffects of Splenectomy and Esophagogastric Devascularizationon the Treatment of Portal Hypertension with 2200 Case* |
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| DOI： |
| 中文关键词: 门静脉高压症 脾切除术 贲门周围血管离断术 近期疗效 |
| 英文关键词: Portal hypertension Esophagogastric devascularization Splenectomy Short-termeffect |
| 基金项目:北京市科技计划首都临床特色应用研究专项（Z131100004013041） |
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| 中文摘要: |
| 摘要目的：总结脾切除贲门周围血管离断术治疗门静脉高压症的近期疗效。方法：回顾性分析我院1999 年6 月-2013 年6 月收
治的2200 例择期行脾切除贲门周围血管离断术的肝硬化门静脉高压症患者的临床资料。统计并分析手术前后的止血率、并发症
及肝功能指标等。结果：近期随访率78%(1716/2200)；其中，上消化道出血史88.3%(1515 例)，手术止血率为99.1%(1701 例)，围术
期病死率为1.3%(22 例)，主要死亡原因为感染和肝肾功能衰竭；并发症情况：发热39.8%(683 例)、腹腔内出血2%(34 例)、门静脉
系统血栓51%(875例)、胸腹腔感染3.7%(63 例)、肝脓肿0.7%(12 例)、胃瘘0.3%(5 例)及胰瘘0.3%(5 例)。丙肝肝硬化脾切除抗病
毒103 例，预防手术112 例，丙肝切脾抗病毒、预防手术围手术期无死亡；肝功能Child 分级：术前85%为A 级，术后94%为A 级；
ALB、TBil、PT 及腹水消失率均明显好转。结论：脾切除贲门周围血管离断术对门静脉高压症引起的上消化道出血具有积极的作
用，可获得较好的近期疗效，并发症经对症处理可消除或缓解，但如何有效降低术后门静脉系统血栓的形成仍需在今后的临床实
践中深入研究。 |
| 英文摘要: |
| ABSTRACT Objective:To summarize the short-termeffects of the splenectomy combined with the esophagogastric devascularization
on the treatment of portal hypertension. Methods:A retrospective analysis was performed about the clinical data of 2200 patients who
were treated by the splenectomy and esophagogastric devascularization in our hospital from June 1999 to June 2013. Then the clinical
data, such as the rate of recent bleeding before and after the treatment, the incidence of complications and the liver function of patients,
were collected and analyzed. Results:The rate of follow-ups was 78%(1716); 88.3%(1515) of the patients have the history of upper
gastrointestinal bleeding, 99.1%(1701) were taken the surgical hemostasis; The peri-operative mortality was 1.3%(22) of which the main
reasons were the infection, the dysfunction of liver and kidney; 39.8%(683) were in fever, 2%(34) represented the intra-abdominal
hemorrhage, 51%(875) showed the portal vein thrombosis, 3.7%(63) got the abdominal cavity infection, 0.7%(12) were liver abscess,
0.3%(5) were gastric fistula and 0.3%(5) were pancreatic fistula. There were 103 cases with the hepatitis C cirrhosis undergoing the
splenectomy antiviral, 112 cases were taken the preventive surgery with no one death; 85% patients were sorted to A by the Child
classification of liver function before the surgery, while the percentage went to 94%when completing the treatment; The indexes of ALB,
TBil, PT and the ascites have significantly improved. Conclusion:It is suggested that the short-term effect of the splenectomy combined
with the pericardial blood vessel disarticulation on the prevention of upper gastrointestinal bleeding caused by portal hypertension with
the advantages of better short-termcurative effect and the postoperative complications could be eliminated or reduced by the symptomatical
treatment. However, it is more easily lead to the thrombosis of patients with portal hypertension which might be required to explore
more operative methods. |
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