内镜治疗与断流术治疗门静脉高压的效果比较

摘要

目的：比较内镜治疗与断流术对门静脉高压的治疗效果。方法收集2010年1月－2012年1月沈阳军区总医院101例肝硬化合并食管胃底静脉曲张破裂出血患者的临床资料，其中内镜下联合治疗53例（内镜组），断流术治疗48例（断流术组），比较两组患者肝功能、脾亢变化以及术后再出血率和并发症情况。计量资料采用均数±标准差（x ±s）表示，计数资料采用例数或百分率表示，两组间比较计量资料采用t检验，计数资料采用χ2检验。结果内镜组术后肝脏储备功能较术前变化不明显（P值均＞0.05）；断流术组术后白蛋白水平与术前比较下降，差异均有统计学意义（t＝2．512，P＜0．05）；内镜组术后白细胞、血小板与术前相比变化不明显（P值均＞0．05），断流术组术后白细胞、血小板与术前相比升高，差异均有统计学意义（P值均＜0．05）；两组术后累计再出血率比较3个月7．5％和6．2％（χ2＝0．066，P＞0．05），6个月7．5％和8．3％（χ2＝0．021，P＞0．05）及1年9．4％和8．3％（χ2＝0．038，P＞0.05）；两组术后并发症发生率分别为24．5％和50％，差异有统计学意义（χ2＝7．040，P＜0．05）。结论肝硬化门静脉高压内镜联合治疗与断流术相比，内镜治疗对患者损伤小，术后肝功能变化不明显，术后并发症发生率低；对肝硬化食管胃底静脉曲张破裂出血合并脾功能亢进明显的患者，可行断流术。%Objective To compare the clinical efficacy of endoscopic variceal ligation versus pericardial devascularization in the treatment of portal hypertension.Methods The clinical data of 101 cirrhotic patients with gastroesophageal varices and variceal hemorrhage from January 2010 to January 2012 were analyzed.Fifty-three patients received endoscopic variceal ligation,and forty-eight patients received pericardial devascularization.Postoperative changes in liver function and hypersplenism were compared between the two groups.The rate of rehaemorrhagia and incidence of postoperative complications after surgery were compared as well.Continuous data were expressed as mean ±SD,and categori-cal data were expressed as number of cases or percentage.Comparison of continuous data between the two groups was made by independent-samples t test,and comparison of categorical data was made by chi-square test.Results After surgery,the variceal ligation group showed no significant changes in liver reserve function,while the albumin level was significantly decreased in the pericardial devascularization group (t=2.512,P<0.05).There were no significant changes in the counts of white blood cells and platelets in the endoscopic variceal ligation group after surgery (P>0.05),but significant increases in the counts of white blood cells and platelets were detected in the pericardial devascular-ization group (P<0.05).The rates of postoperative haemorrhage in the two groups were:3 months,7.5%vs 6.2%(χ2 =0.066,P>0.05), 6 months,7.5%vs 8.3%(χ2 =0.021,P>0.05),and 1 year,9.4%vs 8.3%(χ2 =0.038,P>0.05).The incidence rates of postopera-tive complications in the two groups were 24.5%and 50%,respectively (χ2 =7.040,P<0.05).Conclusion Compared with pericardial devascularization,endoscopic variceal ligation causes fewer microlesions,preserves liver function,and leads to a lower incidence of postopera-tive complications.However,if hypersplenism is observed in the cirrhotic patients with gastroesophageal varices and variceal hemorrhage,peri-cardial devascularization can be used to control the hypersplenism and prevent esophageal hemorrhage.