2种改良门奇静脉断流术治疗门静脉高压症上消化道出血效果的比较

J4 ›› 2012, Vol. 38 ›› Issue (5): 1008-1012.

2种改良门奇静脉断流术治疗门静脉高压症上消化道出血效果的比较

姚小晓¹|张丹¹|季德刚¹|杨永生¹|解英俊¹|叶研硕¹|王可心²,张学文v

1.吉林大学中日联谊医院肝胆胰外科, |吉林长春 130033；2.吉林大学中日联谊医院麻醉科|吉林长春 130033

收稿日期:2012-06-10 出版日期:2012-09-28 发布日期:2012-09-25
通讯作者: 张丹（Tel：0431-89876752，E-mail：xieshengdan@sohu.com） E-mail:xieshengdan@sohu.com
作者简介:姚小晓（1983-）|男|吉林省长春市人|在读医学博士|主要从事肝胆胰外科疾病的基础与临床研究。
基金资助:
吉林省发展改革委员会科研基金资助课题（吉发改高技［2009］633号）

Comparison of |curative effects between two types of extensivedevascularization around |cardia in treatment of uppergastrointestinal hemorrhage of portal hypertension

1.Department of Hepatobiliary and Pancreatic Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China；2.Department of Anesthesia,China-Japan Union Hospital,Jilin University,Changchun 130033,China

Received:2012-06-10 Online:2012-09-28 Published:2012-09-25

摘要/Abstract

摘要：

目的：对比分析贲门周围血管离断加胃底环行缝扎术与贲门周围血管离断术加应用吻合器食管横断术治疗门静脉高压症上消化道出血的临床疗效。方法：回顾性分析因门静脉高压症上消化道出血行门奇静脉断流术治疗的151例患者，其中行贲门周围血管离断术加胃底环形缝扎术患者122例（胃底环扎组），行贲门周围血管离断术加应用吻合器食下
段横断术患者29例（食管横断组）。对2组患者术前和术后肝功能变化、腹水、肝性脑病、消化道出血、腹腔内血、消化道瘘发生率等围手术期并发症以及远期再出血发生率进行对比分析。结果：与胃底环扎组比较，行贲门周围血管离断术加胃底环形缝扎术对患者肝脏功能及营养状态影响较为明显，住院时间长、术后消化道瘘发生率高P<0.05）。在术后远期再出血情况的对比分析中，食管横断组患者其远期再出血（因曲张静脉破裂再出血及因胃黏膜病变再出血）的发生率为30.0%（15.0%，15.0%），高于胃底环扎组患者的8.5%（4.9%，3.6%）。结论：与贲门周围血管离断加应用吻合器食管下段横断术比较，贲门周围血管离断术加胃底环形缝扎术具有对患者肝脏功能打击小，术后并发症少，住院时间短，能有效控制远期再出血的发生率，且操作简单、易于掌握等优点。


关键词: 门奇静脉断流术；高血压, 门静脉；胃底环形缝扎；上消化道再出血

Abstract:

Objective  To compare the clinical effects of extensive devascularization around the cardia plus cerclage on gastric fundus and extensive devascularization around the cardia plus    application of staplers on esophagus transection for treatment of the upper gastrointestinal hemorrhage of portal hypertension.Methods The clinical data of 151 cases of upper gastrointestinal hemorrhage of portal hypertension with treatment of portal azygous di
sconnection were retrospectively analyzed,including 122 patients with extensive devascularization around
the cardia plus cerclage on gastric fundus (gastric fundus cerclage group) and 29 patients with extensive devascularization around the cardia plus    application of staplers on esophagus transection (esophageal transection group).The  preoperative and    postoperative liver function,ascites, hepaticencephalopathy, astrointestinal bleeding,abdominal hemorrhage,gastrointestinal fistula rate of perioperative complications and long-term recurrent upper gastrointestinal bleeding rate of the patients in two groups were compared.
Results Compared with gastric fundus cerclage group,the more significant impact on patients with liver function and nutritional status,long hospital stay,the high incidence of postoperative gastrointestinal fistula were found in esophageal transection group.In comparative analysis of long-term postoperative bleeding, long-term rebleeding rate of the patients in esophageal transection group(variceal bleeding and  gastric mucosal lesions rebleeding) was 30.0% (15.0%,15.0%) which was higher than that in gastric fundus cerclage group (8.5%) (4.9%,3.6%).
Conclusion Compared with extensive devascularization around the cardia plus    application of staplers on esophagus transection,extensive devascularization around the cardia plus cerclage on gastric fundus has the advantages on liver function,smaller and fewer complications,shorter hospital stay,and can effectively control
the long-term incidence of rebleeding.The operation is simple and easy to grasp.

Key words: portal azygous disconnection;hypertension,portal vein;gastric fundus purse string suture;upper gastrointestinal bleeding

中图分类号:

R657.34

姚小晓|张丹|季德刚|杨永生|解英俊|叶研硕|王可心,张学文. 2种改良门奇静脉断流术治疗门静脉高压症上消化道出血效果的比较[J]. J4, 2012, 38(5): 1008-1012.