断流术治疗门静脉高压症食管静脉曲张破裂出血的疗效分析

摘要

目的:探讨断流术治疗门静脉高压症(portal hypertension,PHT)所致的食管静脉曲张破裂出血的临床疗效.方法:收集2001年1月-2010年12月533例行断流术的PHT患者的临床资料,按断流术术式的不同,分为贲门周围血管离断术(pericardial devascularization,PD)和联合断流术(combined devascularization,CD)；按照治疗目的不同,分为预防性和治疗性治疗；按照手术时机不同,分为择期和急诊手术.比较不同术式、治疗目的、治疗时机下的治疗效果.结果:治疗性CD与治疗性PD在门静脉压力(portal vein pressure,PVP)、手术时间、住院时间方面差异无统计学意义,但前者输血量少于后者.CD术后并发症、手术病死率与PD术相比,差异无统计学意义(P＞0.05).治疗性断流术与预防性断流术相比,PVP、平均手术时间、住院时间差异均无统计学意义；治疗性断流术后的并发症发生率17.3％,病死率1.7％,预防性断流术后并发症发生率8.6％,无病死病例,两组并发症发生率差异有统计学意义(P＜0.05),而病死率差异无统计学意义(P＞0.05).急诊断流术与择期断流术相比,平均手术时间、输血量差异有统计学意义(P＜0.05,P＜0.01),而两组的并发症发生率及病死率差异均无统计学意义(P＞0.05).有出血史的行PD和CD的患者肝性脑病发生率和病死率差异无统计学意义(P＞0.05),出血率差异有统计学意义(P＜0.01)；无出血史的行PD和CD的患者的出血率、肝性脑病发生率和病死率差异无统计学意义(P＞0.05).结论:PD和CD已经成为治疗PHD食管静脉曲张破裂出血的主要术式,只要手术适应症选择适当,急诊断流术和预防性断流术都能够取得良好的治疗效果.%Objective:To investigate the clinical efficacy of devascularization operation in the treatment of portal hypertension (PHT) with variceal bleeding.Methods:The clinical data of 533 cases of PHT who underwent devascularization operations between January 2001 and December 2010 was collected.The devascularization operations were divided into pericardial devascularization (PD) and combined devascularization (CD),prophylactic and therapeutic,emergency and selective operations.The therapeutic effects were compared between different types of surgery,treatment aim or selected time for operation.Results:No significant difference was observed in portal vein pressure (PVP),operation time and the hospital stay in therapeutic CD and therapeutic PD.However,the blood transfusion volume was less in therapeutic CD.No significant difference was observed in complications and surgical mortality between CD and PD (P＞0.05).No significant difference was observed in PVP,average operative time and hospital stay between therapeutic and prophylactic devascularization operation.The complication probability and mortality rate were 17.3 ％ and 1.7 ％ after therapeutic devascularization operation,and they were 8.6 ％ and 0 after prophylactic devascularization operation.Statistical difference was found in complication probability (P＜0.05),but not in mortality rate (P＞0.05).There were statistical differences in the average operative time and blood transfusion volume between emergency devascularization operation and selective devascularization operation (P＜0.05,P＜0.01).However,no significant difference was observed in complication probability and mortality rate (P＞0.05).No significant difference was observed in the incidence of hepatic encephalopathy and mortality between PD and CD group with a history of bleeding (P＞0.05).However,the rate of bleeding showed significant difference (P＜0.01).No significant difference was observed in the rate of bleeding and incidence of hepatic encephalopathy and mortality between PD and CD group without a history of bleeding (P＞0.05).Conclusions:PD and CD have become the major patterns in the surgical treatment of PHT with variceal bleeding.Through selection of the indication properly,both emergency and selective devascularization operations can obtain satisfactory results.