联合断流术治疗食管胃底静脉出血51例分析

摘要

目的：探讨联合断流术治疗门静脉高压症并食管胃底静脉曲张的效果。方法对2005年1月至2013年6月间采用择期联合断流术的51例肝硬化门静脉高压症临床资料进行回顾性分析。结果所有患者均无手术死亡。平均手术时间为(3.6±0.8)h,输血量为(547±120)ml,术后平均住院天数为(10.3±3.2)d。胸腔积液6例(11.8%),腹水7例(13.7%),门静脉血栓12例(23.5%),均无吻合口瘘和吻合口狭窄。肝性脑病0例,再出血率3.9%(2/51)。术后6个月随访,食管胃底曲张静脉消失35例(68.6%),显著改善15例(29.4%),无明显变化者1例(2.0%)。结论联合断流术可以有效治疗食管胃底静脉曲张,并发症少,再出血率低,是一种值得推广的治疗门静脉高压症的手术方式。%Objective To explore the safety and efficacies of combined devascularization operation for esophagogastric varices in patients with portal hypertension due to liver cirrho-sis.Methods The clinical data of 5 1 cases with portal hypertension undergoing combined devasculariza-tion operation from January 2005 to June 2013 were analyzed.Results There was no occurrence of intr-aoperative mortality.The mean operative duration was 3.6 ±0.8 hours,transfusion volume 547 ± 120 ml and mean postoperative hospital stay 10.3±3.2 days.The major complications included pul-monary effusion (n =6, 1 1 .8%),transient ascites (n = 7, 13.7%)and asymptomatic portal vein thrombosis (n =12,23.5%).Rebleeding (n =2,3.9%)was documented during a follow-up peri-od of 6 months.Postoperative endoscopy revealed that varices improved significantly from severe to mild (29.4%)and even disappeared (68.6%).Conclusions With lower rates of complications and bleeding,combined devascularization operation is safe and efficacious for esophagogastric varices in pa-tients with portal hypertension due to liver cirrhosis.