近端胃切除术治疗断流术后再次上消化道出血的临床疗效分析

摘要

Objective To explore the clinical efficacies of Phemister’s operation for upper gastroin-testinal rebleeding after Hassab's in portal hypertension patients.Methods Retrospective analyses were performed for the clinical and follow-up data of 26 cases undergoing Phemister's operation for upper gastrointestinal rebleeding after Hassab’s from June 2009 to January 2014.Results All cases obtained satisfactory hemostasis.The procedures included emergency surgery (n =5 )and endoscopic variceal ligation (EVL)plus jejunostomy (n =1).Two cases of postoperative anastomotic bleeding were cured through conservative measure;one case of postoperative anastomotic leak received parenteral nutrition and unobstructed drainage was successful.During follow-ups,4 cases of esophageal varices respon-ded to EVL.Another case died of upper gastrointestinal rebleeding after 13 months.Conclusions Phe-mister's operation is effective for upper gastrointestinal rebleeding in portal hypertension patients re-sponding poorly to non-surgical measures.%目的：探讨近端胃切除术(Phemister 术)对门静脉高压症行脾切除加贲门周围血管离断术术后再次出血的临床疗效。方法对我院肝胆外科2009年6月至2014年1月收治的26例断流术后再次上消化道出血的患者行近端胃切除术的临床资料及术后随访资料进行分析。结果26例均取得满意的止血效果,其中5例急诊手术,1例行术中胃镜下食管中上段曲张静脉套扎术(EVL)并空肠造瘘留置肠内营养管。2例术后吻合口出血,经输血、药物止血、抑酸及护胃等治疗止血；1例吻合口瘘,经肠外营养及通畅引流等治愈；5例出现大量腹水,经营养、补充白蛋白、利尿等治疗好转。随访中4例发现食管静脉曲张并行 EVL,1例于术后13个月因上消化道出血死亡。结论对于门静脉高压症断流术后再出血患者经药物、内镜或介入(TIPS)等非手术治疗效果不满意者,近端胃切除术治疗效果确切。