环形缝扎加胃底折叠术预防晚期血吸虫病病人术后再出血效果

目的 目的 评估食管下段梯状环形缝扎黏膜下血管及胃底折叠术对晚期血吸虫病 （晚血） 门脉高压症并发上消化道 出血的治疗效果。 方法 方法 2006-2011年选择患晚血门脉高压症患者, 随机分为联合手术治疗组 （联合组） 与单纯手术治疗 组 （单纯组）。单纯组患者行门奇静脉断流术, 联合组在此基础上加行食管下段梯状环形缝扎黏膜下血管及胃底折叠术。 术后通过胃镜检查随访, 比较2种术式的治疗效果。结果 结果 共选择晚血患者158例, 联合治疗组75例, 单纯治疗组83例。 术后两组治疗有效率分别为81.3 % （61/75） 和30.1% （25/83）（χ2 =39.44, P < 0.01）, 发生再出血率分别为2.7 %（2/75） 和 12.0% （10/83）（χ2 =24.36, P < 0.01）, 两组差异有统计学意义。结论 结论 食管下段梯状环形缝扎黏膜下血管及胃底折叠术对 预防术后再出血效果明显, 且术式安全, 可作为治疗晚血门脉高压症的常规手术方式。     

晚期血吸虫病脾切除加周围血管离断术后再出血的手术治疗

目的 目的 观察晚期血吸虫病门静脉高压脾切除术加周围血管离断术后再出血的手术治疗效果。方法 方法 2002年10 月-2011年10月, 采用左侧经胸食管切开曲张静脉缝扎加贲门周围血管再离断术 （部分患者加做胃底大弯侧部分切除术）, 治疗晚期血吸虫病门静脉高压症脾切除加断流术后再出血的患者。随访1～9年, 观察疗效。结果 结果 共手术治疗43例, 其 中择期手术27例, 急诊手术16例, 平均随访时间为6.8年, 止血率为100%。术后死亡1例, 死亡原因为从事重体力劳动后 再出血。2例解黑色柏油样大便, 均经保守治疗后消失。其余病例均恢复良好。结论 结论 左侧经胸食管切开曲张静脉缝扎 加贲门周围血管再离断术治疗晚期血吸虫病门静脉高压症脾切除加断流术后再出血, 效果满意。     

门静脉高压症出血手术治疗的探讨

自1962年1月～1982年12月,我们共手术治疗84例门静脉高压症,其中脾肾静脉分流术49例,门奇静脉断流术20例,门腔静脉分流术4例,门腔静脉“H”型搭桥术2例,肠腔静脉“H”型搭桥术4例,胃底食管切开血管缝扎术4例,胃底切开贲门周围缝扎血管术1例。现就其效果进行探讨。     

血吸虫病门脉高压症外科治疗体会

目的总结脾切除术和脾切除加贲门周围血管离断术治疗血吸虫病门脉高压症的疗效。方法回顾性分析2002年1月~2004年12月采用脾切除术和脾切除加贲门周围血管离断术治疗的18例血吸虫病门脉高压症患者临床资料。结果5例行单纯脾切除术,13例行脾切除加贲门周围血管离断术,术后脾功能亢进均消失,劳动能力及生活质量明显改善。两组各有1例术后发生上消化道出血,近远期无死亡病例,大部分患者肝功能、食管胃底静脉曲张情况得到明显改善。结论根据患者病情选择脾切除术或脾切除加贲门周围血管离断术治疗血吸虫病门脉高压症效果满意。     

门脉高压症的外科治疗趋势兼论贲门周围血管离断术

对门静脉高压症发生的上消化道大出血采用门奇断流术治疗由来已久。自50年代Tanner的近端胃横断加门奇断流,1970年Hassab的胃去血管术和Sugiura的经胸腹胃食管的去血管术、经食管曲     

脾肾静脉分流术联合门奇静脉断流术治疗门静脉高压症临床疗效观察

目的 评价脾肾静脉分流术联合门奇静脉断流术治疗门静脉高压症的疗效.方法 50例门静脉高压症患者分别采用脾肾静脉分流术联合门奇静脉断流术（A组,26例）和单纯门奇静脉断流术（B组,24例）进行治疗,比较两组患者术后肝功能、凝血功能、门静脉压力（FFP）以及胃食管静脉破裂出血再发生率等.结果 A组术后胃食管静脉破裂再出血发生率仅3.8％、FFP为（21.5±2.6）mmHg,B组分别为20.8％、（24.4±3.7） mmHg,两组相比,P均＜0.05.手术前后两组患者的肝功能分级、凝血功能相比,P均＞0.05.结论 脾肾静脉分流术联合门奇静脉断流术治疗门静脉高压症临床疗效明显,而且其治疗效果优于单纯门奇静脉断流术.     

出血区内外缝扎治疗门静脉高压症急性大出血103例分析

对103例门静脉高压症急性大出血患者行食管内出血区黏膜下缝扎,食管外贲门周围血管离断缝扎加脾切除术.近期手术止血率达100%,无手术死亡.随访1 a,生存率100%,远期无1例再发致命性大出血.认为食管内外缝扎血管加脾切除术可及时治疗门静脉高压症急性大出血,止血彻底,符合解剖生理,患者术后生存时间长.     

断流术治疗门脉高压症上消化道出血疗效分析

目的 探讨采用贲门周围血管断流术治疗肝硬化门脉高压并食管胃底静脉曲张破裂出血的效果及预后.方法 对我院3年间行经腹贲门周围门奇血管断流术治疗门脉高压症并发上消化道出血47例及20例保守治疗患者近、远期疗效进行对比分析.结果 手术组除1例近期死亡外,总体效果满意.近期出血5例,远期出血2例,再出血率14.9%,全组无肝性脑病发生.保守治疗组死亡2例,近期出血4例,远期出血6例,1例发生肝性脑病,再出血率50%.结论 规范而彻底的贲门周围血管断流术治疗门脉高压并上消化道出血创伤小,止血率高,肝性脑病等并发症发生率低,便于开展与推广.     

门奇静脉断流术治疗肝硬化门脉高压症的体会

1980年以来,我们对20例肝硬化门脉高压症患者施行了门奇静脉断流术。20例中,18例有出血史,每次出血量均在1000ml以上;均有充血性脾肿大及脾功能亢进,X线示中度以上食管静脉曲张。术前肝功能代偿(Child分级),A级2例,B级12例,C级6例。18例择期手术,2例预防性手术。其中Hassab氏断流术4例,经胸或经胸腹联合门奇静脉断流16例(2例附加胃底血流阻     

急诊门奇静脉断流术治疗门脉高压症所致上消化道大出血26例

肝硬化门脉高压症所致上消化道大出血患者多为乙型肝炎、丙型肝炎所致肝炎肝硬化,60%有饮酒嗜好,肝硬化门脉高压致食道、胃底静脉破裂大出血来势凶猛,死亡率高.我院感染科、普外科1995-2004年收治急诊上消化道大出血行门奇静脉断流术26例,死亡1例,现报告如下.     

Combined TIPS with portal-azygous disconnection improved the long term clinical outcome in portal hypertension patients

Objective

The results of TIPS and the combined TIPS and portal-azygous disconnection for portal hypertension and variceal bleeding were evaluated.

Methods

358 patients with portal hypertension were admitted to our clinical ward because of variceal bleeding. 263 patients underwent TIPS and 95 patients with combined TIPS and portal-azygous disconnection. Portal hemodynamics was evaluated by pressure measurements, venography and Doppler ultrasound before and 2 weeks after the procedure. The rates of shunt patency, rebleeding, encephalopathy and survival were observed during the follow-up period from 1 to 10 years.

Results

The portal pressure and HVPG were decreased significantly after TIPS. TIPS procedure was successfully performed in 97.50% patients. During 1 month after treatment, acute shunt occlusion occurred in 3.42% patients with TIPS and there were no occluded shunts in patients with combined TIPS and portal-azygous disconnection. Encephalopathy was observed in 36.50% patients with TIPS and 18.95% with combined TIPS and portal-azygous disconnection. Recurrent variceal bleeding was documented in 6.46% patients with TIPS and none of patients with combined TIPS and azygous portal disconnection. Thirty-three patients with TIPS and two patients with combined TIPS and portal-azygous disconnection died. During follow-up periods, the patency of shunts in patients with TIPS and patients combined TIPS and azygous portal disconnection was 68.47, 43.84 and 87.06, 57.65% in 12 and 24 months after operation, respectively. The rates of rebleeding, and encephalopathy in patients with TIPS and patients with combined TIPS and azygous portal disconnection were 17.95, 31.79 and 7.04, 16.47%, respectively. The survival rate in 1, 5, 10 years in patients with TIPS and patients combined TIPS and azygous portal disconnection was 87.68, 51.23, 39.90 and 94.12, 81.18, 76.47%.

Conclusion

Combined TIPS and portal-azygous disconnection can improve the effect of TIPS for portal hypertension.     

食管横断法门奇静脉断流术联合肝脾切除术治疗原发性肝癌并脾功能亢进的临床研究

目的探讨原发性肝癌合并肝硬化门静脉高压并脾功能亢进患者手术方式及病例选择对手术效果及安全性的影响。方法对2005-05～2011-11我院收治的60例肝癌合并肝硬化门静脉高压并脾功能亢进行手术治疗患者的临床资料进行回顾性分析。观察组30例应用食管横断法门奇静脉断流术联合肝脾切除术,对照组30例单纯行肝癌切除术。比较两组肝功能分级、肝硬化程度、术前与术后血常规及肝功能变化、术后并发症等指标,判断手术安全性及病例选择对手术效果的影响。结果 60例患者随访5个月～5年,平均(12,3±2)个月,观察组治愈20例,总有效率为96.7%,复发率为16.7%;对照组治愈15例,总有效率为80%,复发率为30.0%,两组差异无统计学意义(P0.05)。对照组术前术后血小板、白细胞变化无明显差异。观察组术后血小板、白细胞较术前明显升高(P0.01)。观察组和对照组术后5年无瘤生存分别为10例(33.3%)和5例(16.7%),差异有统计学意义(P0.05)。结论原发性肝癌合并肝硬化门静脉高压并脾功能亢进患者同期行食管横断法门奇静脉断流术联合肝脾切除术是可行的。     

腹腔镜手术治疗血吸虫病肝纤维化门静脉高压合并胆囊结石

目的 目的 观察腹腔镜胆囊切除术 （LC） 治疗血吸虫病肝纤维化门静脉高压综合征 （门脉高压症） 合并胆囊结石的疗 效。方法 方法 分析2006年6月-2013年6月采用LC治疗的196例血吸虫病肝纤维化门脉高压症合并胆囊结石患者的临床资 料。结果 结果 本组血吸虫病肝纤维化门脉高压症合并慢性结石性胆囊炎154例, 合并急性结石性胆囊炎42例, Child A级160 例, B级36例。189例完成LC; 7例中转开腹, 其中腹腔、 胆囊周围黏连及胆囊三角解剖不清3例, 术中出血, 镜下止血困难4 例。196例全部治愈。结论 结论 LC治疗血吸虫病肝纤维化门脉高压症合并胆囊结石疗效良好。     

贲门周围血管离断术治疗门静脉高压食管静脉曲张破裂出血

目的观察贲门周围血管离断术急诊治疗门静脉高压食管静脉曲张破裂出血的临床效果。方法分析潜江市血吸虫病预防控制所2001-2012年收治的43例急诊贲门周围血管离断术患者临床资料。结果 43例急诊手术患者中,止血成功43例(100%),临床治愈42例(97.67%),肝功能衰竭死亡1例(2.38%)。结论急诊贲门周围血管离断术对门静脉高压食管静脉曲张破裂出血具有良好的治疗效果。     

晚期血吸虫病门脉高压症脾动脉瘤的诊治

目的 探讨晚期血吸虫病门脉高压症中的脾动脉瘤(SAA)的诊治方法。方法 对1974年l0月--2000年12月诊治的12例脾动脉瘤回顾分析。结果 术前经彩色多普勒血流显像(CDFI)检查初步诊断l例，B超(BUS)检查怀疑诊断l例，其余l0例均在术中探查发现。动脉瘤直径1．8—3．5cm。动脉瘤连同巨脾一并切除3例；脾切除后，动脉瘤远近端血管均予缝结扎7例；仅作远端缝扎l例，术后因动脉瘤破裂死亡；动脉瘤切除l例。结论 晚期血吸虫病门脉高压症中的脾动脉瘤常与巨脾同存，且常在术中探查时发现。术中正确处理脾动脉瘤，合理治疗门脉高压症是取得良好疗效的保证。     

Surgical treatment of non-cirrhotic presinusoidal portal hypertension

BACKGROUND/AIMS: Non-cirrhotic portal hypertension has a better prognosis than other forms of portal hypertension because of a well-preserved liver function in most cases. These patients are good candidates to receive surgical treatment, which is the therapeutic choice available with the lowest rebleeding rate. Because of abnormalities in the splanchnic vessels due to the nature of the diseases, many of them cannot be shunted. An extensive esophagogastric devascularization, the complete portoazygos disconnection, was evaluated. METHODOLOGY: A retrospective review of files of 31 patients, among 491 operations between 1991 an 2001 was carried out in a tertiary care Academic University Hospital. Patients comprised those with non-cirrhotic bleeding portal hypertension treated by means of complete portoazygos disconnection. Extensive two-stage (thoracic and abdominal) esophagogastric devascularization with modified transection of the esophagus was performed. Main outcome measures: recurrence of hemorrhage, encephalopathy and survival. RESULTS: Thirty-one patients were treated. In 17 cases (54%) a hypercoagulable state was demonstrated. No operative mortality was observed (0-30 days) with a total of 62 operations (two stages per patient). No case of encephalopathy was observed and in 3 cases (9%) rebleeding was recorded. The survival curve showed a 5-year survival of 97% and a 10-year survival of 93%. CONCLUSIONS: Complete portoazygos disconnection is an excellent surgical alternative for patients with non-cirrhotic portal hypertension, with a low morbidity and mortality as well as a low rebleeding rate and good long-term survival.     

四川省眉山市东坡区16例新发现晚期血吸虫病患者临床特征分析

目的 分析四川省眉山市东坡区新发现晚期血吸虫病（晚血）患者的临床特征,为加强临床医生对该病的诊疗意识、及时开展有效救治等提供依据。 方法 收集四川省眉山市东坡区新发现的16例晚血病人住院病历资料、个案调查表等,对比病人省、区两级诊断及复核情况,明确临床诊断及分型。结果 16例新发现晚血病例平均年龄63岁,其中60岁以上者10例;男、女性患者各8例;10例分布在血吸虫病历史重度流行区;腹水型11例,巨脾型4例,结肠增厚型1例。16例新发现晚血病例主要以腹水、脾大、脾功能亢进、门脉高压等为首发临床表现。15例患者经住院治疗后,皆符合临床好转标准。结论 应加强对晚血的防治工作。临床医生对以门脉高压、肝脾肿大、上消化道出血等症状、体征就诊的患者,需结合流行病学史、临床特征、实验室检查等综合分析、判断,及时诊断和治疗。     

门静脉海绵样变22例临床分析

目的 探讨门静脉海绵样变的临床特点、诊断方法及治疗.方法 对22例门静脉海绵样变患者的临床资料进行回顾性分析.结果 22例患者多以反复呕血便血、脾肿大、脾功能亢进为主要症状;肝功能检查多正常或仅表现为白蛋白的轻度降低.21例经超声检查确诊,1例经门静脉造影确诊.4例患者进行手术治疗,大多行脾切除,分流术加断流术.结论 门静脉海绵样变的临床表现以继发性门静脉高压为主,超声检查多能确诊.内科保守治疗效果不佳,手术以分流加断流术为主.     

Surgical treatment of portal hypertension

Portal hypertension is a common disease with high mortality and serious influence on the life quality of patients. At present, shunt and disconnection are commonly used for the treatment of portal hypertension. In recent years, combined procedures of shunt and disconnection have evoked the potential interest of surgeons. Initial experimental studies and clinical observations showed that the combined procedures are ideal for treating portal hypertension. Transjugular intrahepatic portacaval shunt (TIPS) is a new minimally invasive technique in treating portal hypertension. Some surgeons have tried to perform disconnection under laparoscopy with success. Liver transplantation will be the focus of portal hypertension surgery in the future.