分断流联合术与断流术治疗门静脉高压症的前瞻性对比研究

目的前瞻性观察对比脾肾分流加贲门周围血管离断术与单纯门奇断流术的特点和临床疗效。方法将1984～2004年入院的门静脉高压症360例患者随机分为两组：分断流联合术（250例）和门奇断流术（110例）。通过临床疗效观察、彩色多普勒（DCFI）检查、术中动态观察自由门静脉压（FPP）和数字减影血管造影（DSA），观察手术前后门静脉血流动力学的变化并进行对比研究。结果（1）术后出血：分断流联合术组近期无1例出血，远期出血率为8．0％，断流术组近期再出血率为5．5％，远期再出血率为17．6％（P〈0．05），（2）肝性脑病发生率：分断流组为5．6％，断流组为4．4％（P〉0．05）。（3）门静脉血流动力学变化：分断流术后的FPP降低较断流术后明显（P〈0．05）；分断流术后门静脉直径（DPV）缩小较断流术后明显（P〈0．05）；分断流术后门静脉血流量（PVF）减少与断流术后无明显差异（P〉0．05）。结论分断流联合术降低FPP，较断流术明显，可较为有效的缓解了门静脉学高动力血流状态，且其临床疗效优于断流术。

Comparative prospective study of effects of combined procedure and portal-azygous devascularization on portal hypertension

Objective To compare prospectively the features and effects of combined operation(splenorenal shunt plus portal-azygous devascularization) and portal-azygous devascularization only(PCDV)on portal(hypertension)(PH).Methods We summarized 360 cases of PH admitted from 1984 to 2004.All patients were randomly divided into two groups,one was combined operative group(250 patients) and the other was PCDV group(110 patients).The therapeutic effects and changes of portal hemodynamics were studied with doppler flowmeter(DCFI),free portal pressure(FPP) and digital subtraction angiography(DSA) pre-and post-operatively,and were measured directly during the course of the procedure.Results(1)Postoperative bleeding:Of all the patients who underwent combined operation,no case of rebleeding occurred in the short period after operation,and the rebleeding rate was 8.0% in the long period of follow-up.In the patients who underwent PCDV,the rebleeding rate was 5.5% in the short period after operation,and 17.6% at long-term follow up(P<0.05) postoperatively.(2)The rate of hepatic encephalopathy in the combined operation group was 5.6% and in the PCDV group aws 4.4%(P>0.05).(3)There was a significant decrease in the diameter of portal vein,and FPP postoperatively in the combined operation group compared to PCDV group.There was a significant decreases of PVF in the PCDV group.But the decrease of PVF in the two groups had no significant difference.Conclusions The combined procedure has merits of greater decrease of FPP,and alleviation of the condition of hyperdynamic blood flow in the portal vein.The clinical effect is also better than that of portal-azygous devascularization only.