食管曲张静脉破裂大出血患者出血停止后的近期手术治疗：附52例报告

Operation performed on the shortterm after stop of gastroesophageal variceal bleeding in patients with portal hypertension

摘要:

目的：探讨门静脉高压症食管曲张静脉破裂大出血患者出血停止后近期内行手术治疗的可行性及临床效果。方法：回顾分析52例门静脉高压症食管曲张静脉破裂大出血患者经非手术治疗止血后，1～2周内行手术治疗（断流术或分断联合术）的临床资料。结果：分断联合术组及断流术组术后门静脉压力分别平均降低（9.3±2.25）cmH2O和（3.65±1.52）cmH2O。手术死亡率为5.8%（3/52），术后并发症发生率44.2%（23/52）。断流术组术后近期再出血2例，远期再出血5例（20.0%)；分断联合术组术后近期未再出血，远期再出血1例（5.6%)。术后远期3例（7.0%）发生肝性脑病，其中联合术组2例，断流术组1例。结论：对门静脉高压症食管曲张静脉破裂大出血患者出血停止后1～2周内行手术治疗是安全、可行的；肝功能较好、门静脉压力过高的青壮年患者以分断联合术为宜，而术前肝功能较差（Child C 级）者则应首选断流术。

Abstract:

Objective:To investigate the feasibility and effect of the operation performed on the shortterm after stop of esophageal variceal bleeding(EVB) in patients with portal hypertension. Methods:The clinical data of fifty two cases of EVB undewent pericardiac devascularization (PCDV) operation or combination of PCDV and shunt operation (combined operation) 12 weeks after the EVB stopped were analysed. Results:After operation, the portal pressure in combined operation group and PCDV group was （9.3±2.25）cmH2O and（3.65±1.52）cmH2O respectively. The operative mortality was 5.8% (3/52) and the mobidity was 44.2%（23/52）in this series. No rebleeding occurred in combined operation group,but recurrent bleeding developed in 2 cases in PCDV group during the early postoperative period. The incidence of rebleeding was 5.6% in combined operation group and 20.0% in PCDV group in long followup period. Postoperative encephalopathy occured in 2 cases in combined operation group and 1 case in PCDV group. Conclusions:For the patients with portal hypertension complicated with EVB,surgical therapy 12 weeks after stop of EVB might be a safe and feasible method. Combined operation should be performed on the younger patients with higher portal pressure(>35cmH2O) and the liver function belongs to Child A or B grade;however, if the patient with hepatic function of Child C grade,the first choice of surgical procedure is PCDV.