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我院白2001-02-2003-06共为29例门脉高压症患者施行门体分流加延迟性分流术。现报道如下。 相似文献
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<正>门脉高压症采用外科手术治疗将近半个多世纪,但对其手术时机、分流抑或断流优劣之评价仍无统一认识,尚待进一步探索和研 相似文献
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门脉高压症合并胃癌治疗体会 总被引:1,自引:0,他引:1
门脉高压症合并胃癌的发病率低,但在处理上尚属外科医生棘手问题,择期手术病人,如果食管静脉曲张不重,则以胃癌根治为主加脾动脉结扎,如果食管静脉曲张重或有呕血史,则在胃癌根治基础上行脾切除,冠状静脉、食管静脉、高位食管静脉、胃后静脉结扎。如果胃窦部癌已经超过一区,胃体癌、贲门癌者,则行脾切除加全胃切除。轻、中度食管静脉曲张,则在胃癌根治基础上行脾动脉结扎。急症手术者,要根据病人全身情况、肝功能情况,遵循“个体化”原则。既要控制出血,又要考虑胃癌根治术。但在大出血情况下,首先是保命控制出血。 相似文献
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门静脉高压症是一组由门静压力持久增高引起的症侯群。正常门静脉压力为10~14cm水柱(7~10mmHg),当门静脉与下腔静脉之间压力梯度上升至12mmHg或更高时,就会发生门静脉高压的并发症。根据发病原因和病变部位。将门静脉高压症分肝前型、肝内型、肝后型及特发性门脉高压症。门脉高压症绝大多数由肝硬化引起,肝硬化的病因主要是乙肝或丙肝病毒及酒精,其次为血吸虫。约80%以上的肝硬化患者都有门脉高压的临床表现,在确诊的肝硬化患者食管静脉曲张可高达50%以上,无食管静脉曲张患者随病程推移亦有发生静脉曲张的危险性。食管静脉曲张破裂出血是门脉高压症十分严重的并发症,其死亡率极高,而再出血率及再出血病死率亦相当高。 相似文献
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门脉高压上消化道出血是临床常见多发病,手术治疗术式繁多。迄今尚无十分理想的方式,我们采用了较合理的高选择性分流术即胃冠状静脉—肾静脉分流术治疗2例门脉高压上消化道出血病人,疗效满意,现报告如下。1病历摘要例1:男,18岁。1982年北京儿童医院诊断为... 相似文献
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门静脉高压症(portal hypertension,PH)是以门静脉(PV)系统的血流受阻、血液瘀滞、门静脉压力增高为特点的一组症候群[1].目前门静脉高压症治疗方式仍以手术为主,主要包括断流术、分流术及断分流联合术.因门脉高压症病因及临床表现不尽相同,术式的选择上存在较大差异[2],如何针对性的选择最佳术式达到最佳疗效,成为临床工作中面临的常见问题.我院治疗门脉高压症患者66例,根据疾病病因及临床表现选择合适的术式,现将不同术式的疗效及临床应用情况总结分析如下. 相似文献
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门脉高压症是一种由于各种原因造成患者门静脉高压的疾病,主要表现为呕血、黑便,不仅带给患者生理上的痛苦,还带给其精神上的折磨[1].笔者对采用腹腔镜手术治疗门脉高压症患者80例的护理方法进行分析,现报道如下. 相似文献
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STORER J 《The Ohio State medical journal》1957,53(4):416-418
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González-Abraldes J Bosch J García-Pagán JC 《Current opinion in investigational drugs (London, England : 2000)》2001,2(10):1407-1413
In liver cirrhosis, increased resistance to portal blood flow is the primary factor in the pathophysiology of portal hypertension. The recognition of a dynamic component in hepatic resistance due to the active-reversible contraction of different elements of the portohepatic bed, has led to the active development of hepatic vasodilators. On the other hand, a significant increase in portal blood flow caused by arteriolar splanchnic vasodilation and hyperkinetic circulation, aggravates portal hypertension and provides the rational for the use of splanchnic vasoconstrictors, such as beta-blockers, vasopressin derivatives and somatostatin and its analogs. This review covers current developments in the treatment of portal hypertension. 相似文献
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Shunts and devascularizations have totally different effects on the hemodynamics of the portal venous system. The actual results
of pericardial devascularization (PCDV) alone and conventional splenorenal shunt combined with pericardial devascularization
(combined procedure, CP) should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics
in the portal venous system after CP and PCDV only. In 20 patients who received CP and 18 who received PCDV, hemodynamic parameters
of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free
portal pressure (FPP) was continuously detected by a transducer during the operations. Compared to the preoperative data,
a decreased flow in the portal vein (PVF) [(563.12 ± 206.42) mL/min vs (1080.63 ± 352.85) mL/min, P < 0.05], a decreased portal vein diameter (PVD) [(1.20 ± 0.11) cm vs (1.30 ± 0.16) cm, P < 0.01], a decreased FPP [(21.50 ± 2.67) mmHg vs (29.88 ± 2.30) mmHg, P < 0.01] and an increased flow in the superior mesenteric vein (SMVF) [(1105.45 ± 309.03) mL/min vs (569.13 ± 178.46) mL/min, P < 0.05] were found in the CP group after operation; a decreased PVD [(1.27 ± 0.16) cm vs (1.40 ± 0.23) cm, P < 0.05], a decreased PVF [(684.60 ± 165.73) mL/min vs (1175.64 ± 415.09) mL/min, P < 0.05], a decreased FPP [(24.40 ± 3.78) mmHg vs (28.80 ± 3.56) mmHg, P < 0.05] and an increased SMVF [(697.91 ± 121.83) mL/min vs (521.30 ± 115.82) mL/min, P < 0.05] were observed in the PCDV group. After operation, PVF in the CP group [(563.12 ± 206.42) mL/min vs (684.60 ± 165.73) mL/min, P > 0.05] had no significant decrease, while FPP [(21.50 ± 2.67) mmHg vs (24.40 ± 3.78) mmHg, P < 0.01] had a significant decrease as compared with that in the PCDV group. PVF and FPP could be decreased by both surgical
procedures, but the effect of decreasing FPP was much better in the combined procedure than in PCDV alone. Further, there
was no significant difference in PVF between the two groups. It is suggested that the combined surgical procedure could integrate
the advantages of shunting with those of devascularization, as well as maintaining the normal anatomic structure of hepatic
portal system, thus it should be one of the best choices for patients with portal hypertension when surgical interventions
are considered. 相似文献
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保留迷走神经主干的贲门周围血管离断术治疗门静脉高压症临床体会 总被引:1,自引:0,他引:1
目的 :探讨保留迷走神经主干的贲门周围血管离断术 (VTPPD)比较于切断迷走神经主干的贲门周围血管离断术加幽门成形术 (PD+PP)治疗门脉高压症的治疗效果。方法 :回顾性分析 1999— 10~ 2 0 0 3— 0 5实施的 VTPPD31例与 PD+PP4 8例 ,比较两组病人手术并发症 ,死亡率。结果 :VTPPD组手术死亡率为 9.7% ,PD+PP组手术死亡率为 12 .5 % ,两者死亡率无明显差异 (P >0 .0 5 ) ;VTPPD组并发症明显低于 PD+PP组 (P <0 .0 1)。结论 :保留迷走神经主干的贲门周围血管离断术能够降低术后并发症 ,提高门脉高压症手术的远期疗效。 相似文献
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Hemstreet BA 《Pharmacotherapy》2004,24(1):94-104
Development of bleeding gastroesophageal varices is a serious consequence of portal hypertension secondary to cirrhosis. Nonselective beta-blockers have been used to reduce portal pressures and prevent primary and secondary bleeding episodes. However, up to two thirds of patients may not respond appropriately to these agents. Nonselective beta-blockers combined with vasodilatory drugs result in enhanced lowering of portal pressures by targeting several mechanisms involved in this process. Unfortunately, this practice is associated with increased adverse effects, such as hypotension, and minimal reductions in mortality. Carvedilol possesses both nonselective beta-antagonist and alpha1-receptor antagonist activity. Given its combined mechanism of action, carvedilol presents a potential option for lowering portal pressures. Its effects on lowering portal pressures and its role in therapy are undefined. Using MEDLINE (1966-2003) and International Pharmaceutical Abstracts (1970-2003), the English-language literature was searched to identify human studies assessing carvedilol's effects on lowering portal pressure. In general, carvedilol therapy was associated with mean reductions of 16-43% in portal pressure, assessed by the hepatic venous pressure gradient (HVPG) after single and multiple doses. Studies comparing carvedilol with propranolol revealed equal or enhanced efficacy in lowering HVPG. Large percentages of patients had significant HVPG reductions to levels that prevent variceal bleeding. Carvedilol also was associated with substantial symptomatic hypotension, especially in patients with ascites or Child-Pugh class B or C cirrhosis. Efficacy and adverse effects generally seem to be dose related. Carvedilol appears to be a potentially viable option for treating portal hypertension. Further multiple-dose trials comparing carvedilol with standard therapy are needed to assess the agent's long-term safety and effectiveness in preventing variceal bleeding. 相似文献
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目的 探讨门静脉宽度测量作为评价普萘洛尔治疗门脉高压的价值.方法 将本院2005年1月~2010年1月收治的102例肝硬化失代偿期患者随机分成两组,普萘洛尔组54例,对照组48例,两组治疗前后分别进行肝功能化验及B超测量门静脉宽度,比较其变化是否有差异.结果 治疗前两组肝功能损害及门静脉宽度比较差异无统计学意义(P>0.05),两组病情轻重相同.治疗3个月后普萘洛尔组肝功能明显好于对照组,门静脉宽度亦较对照组有明显缩小(P<0.01).结论 普萘洛尔组治疗后肝功能改善及门静脉宽度缩小与对照组比较有显著差异,提示门静脉宽度测量可作为评价普萘洛尔治疗门脉高压疗效的简易指标. 相似文献
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目的探讨分流术与脾切除及贲门周围血管离断术对门静脉高压症的治疗作用。方法回顾该院从2005年6月至2012年6月共113例采用脾切除及贲门周围血管离断术与分流术治疗门脉高压症患者的临床资料,分析手术前后患者脾功能亢进症状、肝功能、食管胃底静脉曲张等情况,比较两者的手术死亡率及术后再出血、肝性脑病和门静脉血栓的发生率。结果治疗后两组患者自由门静脉压(free portal pressure,FPP)均明显低于治疗前,治疗前后比较差异有统计学意义(P0.05),两组患者治疗后FPP差异无显著性,无统计学意义(P0.05);治疗后及随访期间,分流组分流术组术后食管胃底静脉曲张减轻率和腹水消失率优于断流组,差异有统计学意义(P0.05),近期肝功能好转情况两组间差异无统计学意义(P0.05);术后随访患者,分析两组患者术后再出血、肝性脑病和门静脉血栓的发生率,分流组再出血及门静脉血栓发生率低于断流组,两者差异有统计学意义(P0.05);断流组肝性脑病发生率显著低于分流组,两者差异有统计学意义(P0.01)。结论对于门静脉高压症患者,脾切除及贲门周围血管离断术相比分流术具有更好的治疗效果,该手术方法具有肝性脑病不易发生,较好的维持入肝血流且止血彻底,肝功能影响小的优势,且手术创伤较小、手术死亡率低、操作简便,易于在基层推广。 相似文献
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《Expert opinion on pharmacotherapy》2013,14(16):2599-2607
Importance of the field: It is important to know which patients with hypertension will benefit from beta-blocker therapy and which beta-blockers should be used in the treatment of hypertension to reduce cardiovascular events and mortality.Areas covered in this review: Studies between 1981 and 2009 using a Medline search are reported. Beta-blockers should be used to treat hypertension in patients with previous myocardial infarction, acute coronary syndromes, angina pectoris, congestive heart failure, ventricular arrhythmias, supraventricular tachyarrhythmias, diabetes mellitus, after coronary artery bypass graft surgery, and in patients who are pregnant, have thyrotoxicosis, glaucoma, migraine, essential tremor, perioperative hypertension, or an excessive blood pressure response after exercise.What the reader will gain: The use of beta-blockers as first-line therapy in patients with primary hypertension has been controversial. However, the 2009 guidelines of the European Society of Hypertension state that large-scale meta-analyses of available data confirm that diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers do not significantly differ in their ability to lower blood pressure and to exert cardiovascular protection both in elderly and in younger patients.Take home message: The key message of this paper is that atenolol should not be used as an antihypertensive drug and that the degree of reduction of mortality, myocardial infarction, stroke and congestive heart failure by antihypertensive therapy is dependent on the degree of lowering of aortic blood pressure. Newer vasodilator beta-blockers such as carvedilol and nebivolol may be more effective in reducing cardiovascular events than traditional beta-blockers, but this needs to be investigated by controlled clinical trials. 相似文献