脾腔分流加断流术治疗门静脉高压症上消化道出血

目的　观察脾腔分流加断流联合手术治疗门静脉高压症上消化道出血的疗效。方法　回顾性总结此术式治疗门静脉高压症上消化道出血56例的疗效。结果　手术死亡率为36%,术后近期无出血。远期再出血率41%。肝性脑病发生率为20%。术后1,3,5,10年生存率分别为981%,939%,825%,667%。结论　脾腔分流加断流术,既保留了断流术的优点,又降低了门静脉压力,特别对门静脉高压性胃病出血有较好疗效,并能保持一定量的门静脉向肝血流,有利于肝功能的恢复。

Combination of splenocaval shunt with portaazygous devascularization for portal hypertension with upper digestive tract hemorrhage

Objective To observe the effect of combination of splenocaval shunt with portaazygous devascularization for portal hypertension with upper digestive tract hemorrage. Methods A retrospective summary was made on 56 cases of portal hypertension with hemorrhage treated by the combined operation. Results There was no rebleeding at the early stage of postoperation in the series with operative mortality 3.6%. The incidence of long term rebleeding and hepatic encephalopathy was 4.1% and 2.0% respectively. Postoperative survival rates of 1,3,5and 10years were 98.1%, 93.9%,82.5% and 66.7% respectively. Conclusions Combination of splenocaval shunt with portaazygous devascularization not only keeps the advanatages of portaazygous devascularization, but also reduces the portal pressure and has especially effective for portal hypertensive gastropathy hemorrhage, and it is able to ensure remarkable hepatopetal blood flow of portal vein to facilitate the recovery of liver function.