门静脉高压上消化道大出血介入断流术与外科断流术效果比较

目的 评价介入断流术与外科断流术治疗门静脉高压症食管胃底曲张静脉出血的临床效果.方法 回顾性分析48例行介入断流术和51例行外科断流术的肝硬化门静脉高压症患者的临床资料,比较2组患者的一般情况和术后临床效果、并发症发生情况、再出血时间.计数资料采用X2检验,计量资料采用t检验.结果 2组患者的年龄、性别、病程及术前的疾病严重程度差异无统计学意义(P>0.05).介入断流术后患者12、24、36个月再出血率分别为12.5%(6/47)、24.5%(11/45)、27.9%(12/43);外科断流术后患者分别为29.2%(14/48)、44.7%(21/47)、48.9%(22/45),2组差异有统计学意义(X2值分别为3.843、4.150、4.083,P值均<0.05).介入断流术的并发症为:发热85.4%(41/48),腹痛81.3%(39/48),门静脉血栓4.2%(2/48),腹腔内出血2.1%(1/48),感染2.1%(1/48)和死亡2.1%(1/48);外科断流术的并发症为:发热68.6%(35/51),腹痛62.7%(32/51),大量腹水25.5%(13/51),门静脉血栓37.3%(19/51),脾静脉血栓11.8%(6/51),肝性脑病3.9%(2/51),肝肾综合症2.0%(1/51),腹腔内出血2.0%(1/51),死亡3.9%(2/51)以及感染15.7%(8/51),2组并发症中腹痛、发热、门静脉血栓、脾静脉血栓、大量腹水比较差异有统计学意义(X2值分别为4.174、3.098、16.199、6.011、5.536、14.085,P值均<0.05).结论 介入断流术治疗门静脉高压症上消化道出血是一种简单、安全、有效的方法,其临床效果优于外科断流术.

Comparison of intervertional devascularization and surgical devascularization in treatment of upper gastrointestinal hemorrhage for portal hypertensive

Objective To evaluate the clinical effect of intervertional devascularization and surgical devascularization in treatment of patients with upper gastrointestinal hemorrhage .Methods Ninety-nine cases treated with intervertional devaacularization or surgical devascularization were retrospectively studied including 48 cases in intervertional group and 51 cases in surgical group.The postoperative resection, complications and rebleeding time were compared by X2 test and t test between two methods.Results The 12 months, 24 months and 36 months cumulative rebleeding rates after intervertional devascularization were 12.5% (6/47) ,24.5% (11/45), 27.9% (12/43) respectively.The rate after surgical devaacularization were 29.2% (14/48) ,44.7% (21/47), 48.9% (22/45) respectively.There were statistically significant differences between the intervertional and surgical groups (X2=3.843,4.150,4.083, P < 0.05).The complications of intervertional devascularization included fever 85.4% (41/48), bellyache 81.3% (39/48), portalvein thrombosis 4.2% (2/48), intraabdominal hemorrhage 2.1% (1/48), infection 2.1% (1/48) and death 2.1% (1/48).The complications of surgical devaacularization included fever 68.6% (35/51), bellyache 62.7% (32/51), generous hydroperitoneum 25.5% (13/51), portalvein thrombosis 37.3% (19/51), splenic vein thrombosis 11.8% (6/51), hepatic encephalopathy 3.9% (2/51), hepatorenal syndrome 2.0% (1/51), intraabdominal hemorrhage 2.0% (1/51), death 3.9% (2/51) and infection 15.7% (8/51).There were statistically significant differences of fever, bellyache, generous hydroperitoneum, portalvein thrombosis, splenic vein thrombosis between the intervertional and surgical groups(X2=4.174,3.098,16.199,6.011,5.536,14.085,P <0.05).Conclusions The intervertional devascularization procedure is simple, safe and effective method for treating upper gastrointestinal hemorrhage for portal hypertensive.The clinical effect is better than that of surgical devascularization.