贲门周围血管离断术与双介入术治疗肝硬化门静脉高压症伴上消化道出血的疗效观察

摘要

目的 探讨贲门周围血管离断术与双介入术治疗肝硬化门静脉高压症伴上消化道出血的临床疗效.方法 120例肝硬化门静脉高压症伴上消化道出血患者, 根据手术方式不同分为对照组 (采用贲门周围血管离断术治疗) 和研究组 (采用双介入术治疗) , 各60例.对比两组患者的临床疗效.结果 研究组术后6 h止血成功率为96.67％, 明显高于对照组的83.33％, 差异有统计学意义 (P＜0.05) , 两组术后12 h止血成功率均为100.00％, 比较差异无统计学意义 (P＞0.05) .入院时, 两组患者门静脉压力、门静脉压力梯度变化对比, 差异无统计学意义 (P＞0.05) ;治疗后, 两组患者门静脉压力、门静脉压力梯度均低于本组入院时, 研究组患者门静脉压力、门静脉压力梯度变化均低于对照组, 差异具有统计学意义 (P＜0.05) .两组术中均未发生相关并发症.术后住院期间, 研究组发生1例切口感染, 并发症发生率为1.67％;对照组发生1例切口感染, 1例门静脉血栓, 并发症发生率为3.33％, 对比差异无统计学意义 (P＞0.05) .结论 肝硬化门静脉高压症伴上消化道出血患者应用双介入术治疗比贲门周围血管离断术的效果更好, 值得临床推广.%Objective To discuss the clinical efficacy of pericardial devascularization and double interventional therapy for cirrhotic portal hypertension with upper gastrointestinal bleeding. Methods A total of 120 patients with cirrhotic portal hypertension with upper gastrointestinal bleeding were divided by different surgical methods into control group (receiving pericardial devascularization) and research group (receiving double interventional therapy) , with 60 cases in each group. The clinical efficacy in two groups was compared. Results The research group had obviously higher hemostasis success rate in postoperative 6 h as 96.67％ than 83.33％ in the control group, and the difference was statistically significant (P＜0.05). Both groups had hemostasis success rate in postoperative 12 h as 100.00％, and the difference was not statistically significant (P＞0.05). At admission, both groups had no statistically significant difference in portal vein pressure, portal pressure gradient changes (P＞0.05). After treatment, both groups had lower portal vein pressure, portal pressure gradient than those at admission, and the research group had lower portal vein pressure, portal pressure gradient changes than the control group. Their difference was statistically significant (P＜0.05). No complications occurred in both groups during operation. During hospitalization after operation, the research group had 1 case of incision infection, with incidence of complications as 1.67％, while the control group had 1 case of incision infection and 1 case of portal vein thrombosis, with incidence of complications as 3.33％. Their difference was not statistically significant (P＞0.05). Conclusion Double interventional therapy is more effective than pericardial devascularization in patients with cirrhosis and portal hypertension with upper gastrointestinal hemorrhage, and it is worthy of clinical promotion.