联合断流术治疗门静脉高压预防上消化道出血疗效分析

摘要

目的：探讨联合断流术治疗门静脉高压预防上消化道出血的疗效及治疗体会。方法：51例在脾切除、贲门周围血管离断的基础上，经腹以管状吻合器离断吻合食管下段而切断肌层及黏膜层血管(即联合断流术)，预防门静脉高压患者上消化道出血。分析联合断流术围手术期准备、手术时机、手术方式、术后营养支持、术后治疗及并发症的处理等。结果：痊愈出院50例，病死1例，吻合口瘘1例，吻合口狭窄1例。术后出现不同程度腹水23例，发热9例。随访7年，无再次出血。结论：联合断流术是治疗门静脉高压预防上消化道大出血的有效方法。%Objective:To explore the effects of the combined disconnection operation on preventing upper gastrointestinal hemorrhage of patients with portal hypertension. Methods:The muscle layer and mucosa blood vessels of lower esophagus were cut off using tubular anastomat through abdomen in 5 cases after splenectomy and cutting off peripheral vascular of cardia,which could prevent the upper gastrointestinal hemorrhage of patients with portal hypertension. The operation preparation, operation time, operation means and complication treatment of joint cut-out operation were analyzed. Results:Cure in 50 cases,death in 1 case,anastomotic fistula in 1 case and anastomotic stenosis in 1 case were found. Different degree ascites in 23 cases and fever in 9 cases were found after operation. All cases were followed up for 7 years,no hemorrhage occurred. Conclusions:The combined disconnection operation is an effective method to treat the upper gastrointestinal hemorrhage of patients with portal hypertension.