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1.
门静脉高压症不同术式对门奇静脉侧支循环的影响   总被引:4,自引:1,他引:3  
目的评价内镜结扎、断流术与腔内外联合断流对门奇静脉侧支循环的影响。方法 115例患者随机分为内镜结扎组(54例)、断流手术组(30例)、腔内外联合断流组(31例),在治疗前后用微探头超声检查食管下段静脉,彩色多普勒超声检测奇静脉血流动力学各项指标。结果治疗后内镜结扎组食管静脉曲张消失但周围静脉侧支仍存在;断流组食管周围静脉侧支减少但静脉曲张无明显变化;联合组食管静脉曲张和周围静脉侧支均显著减少或消失。3组奇静脉血流量较术前分别下降31%、32%和43%。结论腔内外联合断流较单一的治疗方法能更好地阻断门奇静脉侧支血流。  相似文献   

2.
目的研究腔内外联合断流术对门奇静脉侧支循环的影响。方法2001年3月至2004年5月时腔内外联合断流术治疗43例的门静脉高压食管静脉曲张病人,运用微探头超声检查治疗前后食管下段静脉结构的情况,并进行对比研究。结果治疗后病人食管黏膜下曲张静脉消失,食管周围静脉丛曲张程度也明显减轻或消失。短期追踪随访静脉曲张的再发率和出血率分别为2.5%和0。奇静脉内径较治疗前有所变小,血流速度无明显改变,血流量较前下降43%。结论腔内外联合断流能有效地闭塞食管下段壁内外的静脉,阻断门奇静脉分流,防治食管静脉曲张出血与复发,而且操作简便,值得推广应用。  相似文献   

3.
食管胃底静脉丛是门脉系统中一个重要的侧支循环,门脉高压症时,食管曲张静脉破裂出血是其最严重的并发症,也是导致死亡的主要原因。其中,经内镜食管曲张静脉套扎术(Endoscopic varices ligation,EVL)、非选择性贲门周围血管离断术(Hassab’s procedure)以及腔内外联合断流术(EVL+Hassab’s procedure)是治疗食管静脉曲张,  相似文献   

4.
分流加断流术治疗食管曲张静脉破裂出血100例分析   总被引:5,自引:0,他引:5  
分流加断流术治疗食管曲张静脉破裂出血100例分析第四军医大学唐都医院普外科(西安,710038)高德明吴金声何泽生马庆久保庭毅我院自1978~1996年采用脾肾分流(SRS)加贲门周围血管离断(PCDV)联合术(下简称联合术)治疗食管曲张静脉破裂大出...  相似文献   

5.
吻合器在联合断流术中的应用   总被引:3,自引:0,他引:3  
20世纪 70年代Vankemmel和Rinecker分别创用胃肠道对端和侧侧吻合器阻断食管和胃底壁间曲张静脉 ,简化了手术操作 ,使手术更为安全有效。国内蔡成机应用国产GF管状吻合器和CF侧侧吻合器治疗食管曲张静脉出血。现将吻合器在联合断流术应用的现状作一评述。一、吻合器在联合断流术应用的机理Yamamoto研究食管贲门部位曲张静脉丛分为三组 :即食管及贲门周围的曲张静脉丛、肌间曲张静脉丛和粘膜下曲张静脉丛。而肌层曲张静脉丛是将食管周围和粘膜下曲张静脉联接起来的。单纯的断流术 ,如Hassab术或贲门周围…  相似文献   

6.
Liu B  Xu RY  Qiu WS  Lin N  Chen TF  Huang FZ  Liu XY 《中华外科杂志》2003,41(10):721-723
目的 研究内镜下食管曲张静脉结扎联合部分脾栓塞术治疗门静脉高压症的临床疗效。方法自1999年5月至2003年2月对68例合并食管静脉曲张和脾功能亢进的门静脉高压症患者实施内镜结扎加部分脾栓塞术进行治疗,观察术后食管曲张静脉闭塞和止血效果及并发症和死亡率,门奇静脉侧支循环情况,并与对照组进行对比。结果联合术后患者食管曲张静脉获得根治,脾功能亢进缓解,门静脉血流速度减慢,血流量减少(P<0.05),奇静脉血流量降低(P<0.01),胃左静脉血流速度减慢(P<0.05)。术后随访2-24个月,未出现复发性出血。结论内镜结扎联合部分脾栓塞术能有效地治疗门静脉高压症食管静脉曲张出血和脾功能亢进,减少了闭塞曲张静脉所需重复结扎次数及近期再出血,对于肝功能较差、难以耐受分流及断流手术的患者尤为适用。  相似文献   

7.
贲门及近端胃壁内外双重断流术治疗门静脉高压症出血   总被引:9,自引:0,他引:9  
目的探索有效治疗门静脉高压症胃底曲张静脉破裂出血的手术方法。方法采用贲门周围血管离断术(壁外断流)加贲门环周粘膜下血管缝扎和近端胃(胃左动脉平面以上)中点环周缝扎粘膜下血管(壁内断流)。结果本组接受贲门及近端胃壁内外双重断流术49例,其中单行贲门周围血管离断术(壁外断流)21例。断流后自由门静脉压分别为(33±05)mmHg和(210±015)mmHg,两者比较P<001;术后随访3月至8年,双断流组无再出血发生,单断流组3例发生再出血,1例出血死亡。结论贲门及近端胃壁内外双重断流术治疗门静脉高压症胃底曲张静脉破裂出血比贲门周围血管离断术更为合理、彻底和有效  相似文献   

8.
联合断流术治疗食管胃底静脉曲张破裂出血   总被引:8,自引:1,他引:7       下载免费PDF全文
目的:探讨吻合器食管横断联合门奇断流术治疗食管胃底静脉曲张破裂出血的效果。方法:将有食管胃底静脉破裂大出血史的门静脉高压症患者120例,随机分为2组,每组60例。联合断流组实施贲门周围血管离断术加吻合器食管下段横断吻合术,对照组仅实施贲门周围血管离断术。观察对比手术后的近期并发症,以及长期随访结果。结果:(1)联合断流组术后总并发症发生率31.7%,对照组为30.0%(P>0.05);(2)术后食管胃底静脉曲张消失率联合断流组优于对照组(P﹤0.01);(3)术后再出血率联合断流组低于对照组(P﹤0.05);(4)两组患者术后肝功能均有不同程度的改善,两组间无统计学差异(P>0.05);(5)联合断流组长期(4~7年)生存率(98.3%)高于对照组(90.0% )(P﹤0.05)。结论:贲门周围血管离断加吻合器食管横断吻合术能更有效地治疗食管胃底静脉曲张,降低再出血率,进一步提高了断流术的疗效。  相似文献   

9.
断流术治疗食管静脉曲张及或出血   总被引:3,自引:0,他引:3  
治疗门静脉高压症伴食管曲张静脉出血的断流术,有各种术式:如结扎术(腔内胃底静脉曲张缝扎术)、离断术(贲门周围血管离断,相当Hassab手术)、横断术(胃底横断术,相当Tanner手术)、切除术(食管下端胃底切除术,相当Phemister手术)以及联合断流术(如贲门周围血管离断加食管下端横断术Suguira手术)等。由于这些手术对肝功能  相似文献   

10.
目的观察Hassab手术联合食管曲张静脉套扎术治疗门静脉高压症食管静脉曲张破裂出血的临床疗效。方法将近5年间收治的93例门静脉高压症食管静脉曲张破裂出血的患者随机分成3组,分别实施单纯性内窥镜食管曲张静脉套扎术(endoscopic variceal ligation,EVL)、贲门周围血管离断术(Hassab手术)及EVL联合Hassab手术(联合治疗组),对其临床效果进行比较分析。结果3组急性止血率无差异(P〉0.05);联合手术组术后近期无出血,远期再出血率为5.7%明显低于EVL组和Hassab手术组(P〈0.05);术后EVL组、Hassab手术组、联合手术组的奇静脉血流量分别下降22.7%,30.4%,45.7%。结论联合手术组同时阻断了胃食管腔内外的异常门奇静脉分流,食管曲张静脉获得根治,且有脾功能亢进消失、奇静脉血流量降低明显、止血效果确切、再出血率低等优点,是治疗门静脉高压症食管静脉曲张破裂出血的合理而可行的术式。  相似文献   

11.
目的 比较内镜下食管静脉套扎术(EVL)联合硬化剂注射(EVS)和食管胃底静脉断流术对食管胃底静脉曲张破裂出血的近期和远期疗效,探讨EVL结合EVS和两种方法单独应用的适应证。方法12例肝硬化门脉高压症患者行食管胃底静脉断流术,术后胃镜观察曲张静脉消失程度及合并出血的情况,其中6例术后做了EVL或EVS;32例行EVL结合EVS;9例单纯行EVS;5例单纯行EVL。所有病例术后随访3年,观察曲张静脉消失和复发程度以及出血情况。结果 食管胃底静脉断流术为急诊止血的可靠方法,但术后仍存在程度不同的曲张静脉,术后3年内再出血发生率高达66.7%(8/12),术后择期行EVL或EVS,曲张静脉可完全消退。EVL结合EVS曲张静脉完全消退达93.75%(30/32),总疗程2-3周。内镜下治疗后3年内观察曲张静脉复发率仅为10.53%(4/38),再出血发生率为6.52%(3/46)。结论EVL结合EVS对食管胃底静脉曲张破裂出血的近期和远期疗效明显优于手术组。食管胃底静脉断流术后施行EVL和/或EVS可以同时达到降低门脉高压和消除曲张静脉目的。EVL结合EVS明显优于两者单独应用的疗效,同时避免了单纯用EVS容易引起出血的可能性,并且缩短了单纯用EVL的疗程,克服了后期套扎的难度。  相似文献   

12.
内镜下硬化与套扎治疗食管静脉曲张破裂出血疗效比较   总被引:2,自引:0,他引:2  
目的:对比内镜下硬化治疗(EIS)、套扎治疗(EVL)及套扎联合硬化治疗(ESL)3种方法对食管静脉曲张破裂出血的临床疗效。方法:回顾分析中日友好医院消化内科2001—2005年内镜下治疗肝硬化单纯食管静脉曲张破裂出血149例,其中EIS46例、EVL32例、ESL71例,对3种方法的止血率、静脉曲张消失率及再出血率进行比较。结果:3种治疗方法止血率均在90%以上;静脉曲张消失率分别为EIS80.4%、EVL68.8%、ESL87.3%;2年内再出血率分别为EIS52.2%、EVL59.3%、ESL43.6%,差异无统计学意义(P〉0.05)。结论:内镜下EIS、EVL及ESL治疗肝硬化食管曲张静脉出血均可达到较好效果,临床实践中可结合患者实际情况综合考虑后选择。  相似文献   

13.
Background: Endoscopic ligation (EVL) and endoscopic sclerotherapy (EIS) are both effective in the treatment of bleeding esophageal varices, but the efficacy of the two techniques in the prophylaxis of first variceal bleeding has not been investigated. The aim of this study was to investigate the frequency of first variceal bleeding, the recurrence of varices, and survival after treatment with the two techniques, as compared to a nontreated control group. Methods: A total of 157 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either an EIS group (n= 55), an EVL group (n= 52), or a nontreated control group (n= 50). After the eradication of esophageal varices in the EIS and in EVL groups and in all control patients, the endoscopic examination was performed at 3-month intervals. Results: There were no significant differences between EIS and EVL in the eradication rate of esophageal varices (85% in the EIS group versus 81% in the EVL group). The mean number of sessions required to obtain eradication was lower in the EVL group than in the EIS group (4.8 ± 1.8 versus 6.2 ± 2.0; p= 0.0003), but the recurrence of esophageal varices was higher in the EVL group (31% versus 11%; p= 0.01). Total mortality was significantly lower in the EIS patients than in the controls (20% versus 38%; p= 0.04). It was also lower, but not significantly, in the EVL patients than in the controls (23% versus 38%; p= 0.10). A significant decrease in variceal bleeding was observed both in sclerotherapy cases (20%) and controls (54%; p= 0.0005) and in ligation cases and controls (29%; p= 0.01). No significant difference in bleeding episodes was observed between the sclerotherapy and ligation cases (p= 0.29). No serious complications were observed either in the EIS or EVL groups. Conclusions: EIS and EVL are similarly effective in the prevention of first variceal bleeding. The choice between EIS and EVL depends on the skill of the endoscopic unit. For highly experienced surgeons facing no complications, sclerotherapy seems to be preferable; for all others, it is technically easier to perform ligation. Received: 29 June 1998/Accepted: 18 September 1998  相似文献   

14.
Clinical study of radioisotopic splenoportography in portal hypertension   总被引:1,自引:0,他引:1  
Radioisotopic splenoportography was performed in 55 patients with portal hypertension, in whom 52 had various degrees of esophagogastric varices, and in 20 patients without portal hypertension. In the patients with varices, collateral images were obtained in 50 patients (96%) by this method and no image was obtained in the patients without varices. The rate of positively imaged collaterals was as follows: Esophageal varices 69%, the left gastric vein 85%, the short gastric veins 48%, RI stasis in esophagogastric region 65%, the azygos vein 46%, the subclavian vein 25%, the para-umbilical veins 46%, splenorenal /gastrorenal shunts 19%, the inferior mesenteric vein 17%, the left intercostal veins 6%, and Arantius's duct 4%. These rates were superior to that obtained from the conventional transarterial portography. There were some correlations between RI-images by this method and clinical and laboratory findings; patients with ascending collaterals alone tended to have extensive and severe varices and higher rate of bleeding, on the other hand, variceal bleeding was not found and episodes of portosystemic encephalopathy frequently occurred in patients with descending collaterals alone. After successful sclerotherapy, RI-images of esophageal varices disappeared in 92% of the patients. Radioisotopic splenoportography appears to be a useful diagnostic and follow-up modality for patients with portal hypertension and esophagogastric varices.  相似文献   

15.
G P Stellen  J R Lilly 《Surgery》1985,98(5):970-975
During the past 6 years, 25 consecutive patients with esophageal variceal hemorrhage were treated by esophageal endosclerosis (direct injection of varices with a sclerosing agent). The primary disease in the 25 children was portal vein thrombosis (11 patients), biliary atresia (nine patients), and hepatic cirrhosis from cystic fibrosis (three patients), alpha 1-antitrypsin deficiency (one patient), and neonatal hepatitis (one patient). Thirteen patients were treated during acute, major variceal hemorrhage. Esophageal endosclerosis was repeated at regular intervals until all esophageal varices were obliterated. Twenty-one patients completed therapy. Four patients died: one of a complication of therapy and three of the primary disease. Other than the one death, complications were minor. Recurrent esophageal variceal hemorrhage has not been encountered in follow-up from 9 months to 6 years after completion of therapy.  相似文献   

16.

Background/Purpose

There are various treatment strategies for gastroesophageal varices in children. We studied the therapeutic value of endoscopic variceal clipping (EVC) and ligation (EVL).

Methods

Four hundred ninety-nine endoscopic examinations performed between 1991 and 2005 were retrospectively analyzed. F2 and F3 varices with red color signs on follow-up endoscopy were treated with prophylactic EVC. In variceal rupture cases, EVC and EVL were used in combination.

Results

Eighty-two prophylactic EVCs were done, and variceal progression was prevented in 89.9%. However, some patients had persistent red color signs and required frequent EVC. Ten emergent procedures were done for variceal rupture, and, in 4 cases, EVL was used to arrest massive variceal bleeding. Five patients developed bleeding during follow-up cause by rupture of gastric fundal varices, which probably had been aggravated by prior treatment for esophageal varices.

Conclusions

The control of gastroesophageal varices by routine EVC was satisfactory. However, ruptures during follow-up suggested the importance of controlling gastric fundal varices. Endoscopic variceal ligation is a simple, effective, and safe treatment tool, particularly for ruptured varices. However, it is difficult to treat gastric fundal varices with EVL; this disadvantage of EVL can be overcome by the concomitant use of EVC.  相似文献   

17.
For 64 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and esophagus by endoscopic ultrasonography (EUS). Variously developed intra- or extra-mural vascular structures had a relationship to the endoscopic variceal form, and the communicating (inflow) vessels to varices were found in 35 of 50 primary treated cases (70%). We classified the esophago-gastric varices into three types according to the vascular structure, such as the esophageal type, the esophago-gastric type and the solitary gastric type. From the analyses of these collateral structures, we should select a treatment as follows. In the esophageal type which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophago-gastric type, which has many enlarged inflow vessels, the Hassab operation is effective to devascularize extramural inflow vessels, and the combination of EIS is necessary to sclerous the intramural varices. In the solitary gastric type which is a part of the downward porto-systemic shunt, Hassab operation is recommended to prevent the rupture of varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without intramural running vessel.  相似文献   

18.
Summary In 57 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and the esophagus by endoscopic ultrasonography (EUS). Variously developed intra- and extramural vascular structures had a relationship to the endoscopic variceal form, and communicating (inflow) vessels to varices were found in 28 of the 43 primary cases treated (65%). We then classified the esophagogastric varices into three types according to the vascular structure, such as the esophageal type, esophagogastric type, and solitary gastric type. Based on the analysis of these collateral structures, we selected the treatment as follows. In the esophageal type, which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophagogastric type, which has many enlarged inflow vessels, the Hassab operation is effective in devascularizing the extramural inflow vessels, and the combination of EIS is necessary to sclerose the intramural varices. In the solitary gastric type, which is a part of the downward portosystemic shunt, the Hassab operation is recommended to prevent rupture of the varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without.  相似文献   

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