经腹应用吻合器不同吻合方式治疗食道胃底静脉出血疗效分析

目的总结近4年来在贲门周围血管离断术基础上应用吻合器进行食道横断治疗门静脉高压症的经验．比较不同食道横断吻合方法的疗效。方法回顾分析2000年1月至2003年6月在我院因为门静脉高压症行贲门周围血管离断术加食道横断吻合术的病人98例，比较不同吻合方法的优缺点。结果在两种不同的食道横断吻合方法中，应用食道食道再吻合组32例，围手术期死亡1例(3．13％)，食道胃底瘘2例(6．25％)，无近期内再出血病例发生；应用食道胃底再吻合组66例，围手术期死亡1例(1．52％)．无食道胃底瘘和近期内再出血病例发生。两组病人的术后随访率分别为90．63％(29／32)和95．45%(63／66)，随访时间3个月至3年6个月。在手术半年后的胃镜或食道吞钡检查中．食道食道再吻合组，食道胃底曲张静脉消失者23例(79．31％)，显著改善者6例(20．69％)；食道胃底再吻合组，食道胃底曲张静脉消失者60(95．24％)，显著改善者3例(4．?6％)。结论贲门周围血管离断术同时加用食道横断吻合术治疗肝硬化性门静脉高压症的疗效优良．其曲张静脉消失率很高，围手术期死亡率很低，并发症少，手术操作相对简单，是一种值得推广的门静脉高压症手术方法。两者中以食道横断、食道胃底吻合术疗效更为显著。

Different transabdominal esophagogastric stapling methods for management of variceal bleeding in portal hypertension

Objective To summarize the experience in performing transabdominal esophagogastric stapling (TAEGS) for upper gastrointestinal bleeding due to portal hypertension and evaluate the therapeutic efficacy of the methods of TAEGS. Methods The results of different methods of TAEGS performed in 98 patients with portal hypertension secondary to liver cirrhosis from January 2000 to June 2003 were analyzed and compared. Results There were 1 perioperative death (3.13%) and 2 leakage of anastomosis in 32 cases receiving esophagus-esophagus stapling (EE group). There was 1 perioperative death (1.52%) and no leakage of anastomosis in 66 cases receiving esophagus-gastric stapling (EG group). No rebleeding occurred in both groups. The follow-up rate was 90.93% (29/32) and 95.45% (63/66) in EE group and EG group, respectively. The follow-up duration ranged from 3 months to 3 years and 6 months. The gastroscopy and esophageal barium photography performed 6 months after the operation showed that the gastro-esophageal varices disappeared in 23 patients (79.3%) and 60 patients (95.24%) and was obviously improved in 6 patients (20.69%) and 3 patients (4.76%) in EE group and EG group, respectively. Conclusions The therapeutic effect of pericardial devascularization plus TAGES is satisfactory because of low perioperative mortality, high rate of gastro-esophageal varices disappearance and low occurring rate of complications. The TAGES is better than transabdominal esophagus-esophagus stapling.