胆石症合并门脉高压症手术方式探讨

目的探讨胆石症所致的门脉高压症手术时机和手术方式对患者预后的影响。方法对收治的42例胆石症合并门脉高压症患者,根据Child分级在不同的时间选择不同的手术方式进行手术或介入治疗。结果肝功Child A级的患者,无论行一期分流或断流均有较好的结局;Child B级根据不同病情选择不同的手术时机和方式,仍可以达到较满意的效果;Child C级的患者,即使行简单的外引流或二期手术,仍有半数以上的死亡率。结论胆石症性门脉高压与门脉高压性胆石症是2个完全不同的概念;在胆石症-胆道梗阻-肝纤维化-胆汁性肝硬化-门脉高压症这一疾病发展的不同过程中,Child A级的患者宜采用一期、根治性的手术;Child B、C级的患者,应遵循＂个体化治疗＂原则,以胆石症治疗为重点,尽可能缩小手术和创伤范围。

To explore the operation of cholelithiasis combined portal hypertension

Objective To explore the opportunity and mothed of operation of cholelithiasive portal hypertension(CPH). Methods The patients with CPH were perfomed different opportunties and motheds of operation based on different Child degree,and the clinical data of 42 patients with CPH were analyzed retrospectively. Results The patients of child A function,were perfomed whether portacaval shun or disconnection,got good prognosis; those of child B function,if we chosed the appropriate opportunity and method of operation,they would got good prognosis too;but those of child C ,even if were performed simple surgeration ,got mortality rate more than 50 percent. Conclusion CPH has different conception of portal hypertension cholelithiasive.There are obvious differences in pathogenesis,clinieal diagnosis ,therapy and prognosis. CPH should be treated as severe disease.There are different methods and results of operation in the different stages of the disease from cholelithiasive,hepatic fibrosis,biliary cirrhosis to portal hypertension.The patients of child A function should be adopted radical opertation and those of child B and C should be adhered to the personnel therapeutic principle.The emphasis of therapy is cholelithiasive and narrowing down the scope of operation and trauma.If patients' liver function get worse in a week after operation,they should be given highly attention and abundantly reeament.