Hassab手术联合食管曲张静脉套扎术治疗食管曲张血管破裂出血

目的观察Hassab手术联合食管曲张静脉套扎术治疗门静脉高压症食管静脉曲张破裂出血的临床疗效。方法将近5年间收治的93例门静脉高压症食管静脉曲张破裂出血的患者随机分成3组，分别实施单纯性内窥镜食管曲张静脉套扎术（endoscopic variceal ligation，EVL）、贲门周围血管离断术（Hassab手术）及EVL联合Hassab手术（联合治疗组），对其临床效果进行比较分析。结果3组急性止血率无差异（P〉0．05）；联合手术组术后近期无出血，远期再出血率为5．7％明显低于EVL组和Hassab手术组（P〈0．05）；术后EVL组、Hassab手术组、联合手术组的奇静脉血流量分别下降22．7％，30．4％，45．7％。结论联合手术组同时阻断了胃食管腔内外的异常门奇静脉分流，食管曲张静脉获得根治，且有脾功能亢进消失、奇静脉血流量降低明显、止血效果确切、再出血率低等优点，是治疗门静脉高压症食管静脉曲张破裂出血的合理而可行的术式。     

不同治疗方式对门静脉高压症患者食管下段腔内外静脉的影响

目的 研究内镜结扎、脾切除加贲门周围血管离断术（断流术）、内镜结扎联合部分脾栓塞、内镜结扎加脾切除加贲门周围血管离断术（联合断流术）对食管下段腔内外静脉的影响。方法 将142例患者根据治疗方法的不同分为4组：内镜结扎组（54例）、断流手术组（23例）、结扎联合部分脾栓塞组（34例）、腔内外联合断流组（31例）。运用微探头超声检查食管下段静脉结构的情况,进行治疗前后对比研究。结果 治疗后内镜结扎组黏膜下曲张静脉消失,食管周围静脉丛仍然存在;结扎联合部分脾栓塞组黏膜下曲张静脉消失,食管周围静脉丛曲张较术前减轻;断流组黏膜下曲张静脉存在,程度较前减轻,食管周围静脉丛消失;腔内外联合断流组食管黏膜下和周围静脉丛均消失。后两组治疗后穿静脉的显示率也显著降低。结论 腔内外联合断流能更有效地闭塞食管下段壁内外静脉,阻断门静脉奇静脉分流,防治食管静脉曲张出血与复发。     

脾切除联合内镜曲张静脉结扎术治疗门静脉高压症

目的探讨脾切除联合内镜曲张静脉结扎术治疗门静脉高压症的疗效. 方法 2000年1月～2002年6月对38例门静脉高压症行脾切除联合内镜曲张静脉结扎术.比较手术前后血流动力学指标与胃排空时间变化,观察术后3周、6、12、18个月上消化道出血率、食管曲张静脉消失率、门静脉高压性胃病转归及并发症. 结果术后自由门静脉压、门脉血流速度及血流量均较术前明显下降(P＜0.05).随访6～24个月,平均18.2个月,曲张静脉消失36例(36/38,94.7%),每例平均结扎3次,无复发出血者;门静脉高压性胃病分级与胃排空时间与术前无明显变化(P＞0.05);6例(6/38,15.8%)门静脉血栓形成. 结论脾切除联合内镜曲张静脉结扎术对胃排空及门静脉高压性胃病影响小,术后近期曲张静脉消失率较高,术后并发症亦较少.     

内镜腹腔镜联合治疗肝硬化门静脉高压症食管胃底曲张静脉出血

目的：探讨内镜腹腔镜联合治疗肝硬化门静脉高压症食管胃底曲张静脉出血的可行性。 方法： 23例肝硬化门静脉高压症食管胃底曲张静脉出血患者行食管曲张静脉套扎或胃底曲张静脉组织胶注射后行手助腹腔镜脾切除11例,门奇静脉断流术12例。 结果：21例术后1年内无上消化道出血,2例因出血行再次套扎。1例于2年后患肝癌死亡,1例3年后上消化道出血死亡。 结论：内镜联合腹腔镜治疗肝硬化门静脉高压症曲张静脉出血创伤小,近期止血效果好,是一种切实可行的治疗门静脉高压症并食管胃底静脉曲张出血的方法。     

内镜联合腹腔镜治疗门静脉高压症

目的 探讨经内镜食管曲张静脉套扎联合手助腹腔镜脾切除术治疗门静脉高压症的疗效及其安全性.方法 回顾性分析我们于2001年6月～2006年10月采用内镜下食管曲张静脉套扎术及手助腹腔镜脾切除术治疗肝硬化门静脉高压症38例的临床资料.结果 每例平均套扎治疗2～5次.套扎后食管静脉曲张完全消失27例,静脉曲张由重度降为轻度11例.手助腹腔镜脾切除术无严重并发症发生,无中转开腹及死亡病例.术后1.5周复查,血小板由术前的(35～70)×109/L升至(86～320)×109/L.平均随访18个月,无上消化道出血病例.结论 对于门静脉高压脾功能亢进者行内镜食管曲张静脉套扎术联合手助腹腔镜脾切除术具有微创的优点,是一种安全、有效的治疗方法.     

急诊食管胃底曲张静脉栓塞联合Ⅱ期部分脾动脉栓塞术治疗肝硬化门脉高压症并急性上消化道出血效果观察

目的评估急诊食管胃底曲张静脉栓塞联合Ⅱ期部分脾动脉栓塞术治疗肝硬化门静脉高压症并急性上消化道出血疗效。方法对45例肝硬化门静脉高压症并急性上消化道出血患者行食管胃底曲张静脉栓塞联合Ⅱ期部分脾动脉栓塞术,回顾性分析患者的临床资料。结果 43例患者出血完全缓解,1例术后小量出血经药物治疗后缓解,1例行二次食管胃底曲张静脉栓塞后缓解,无明显手术并发症。术后随访1 a,40例未再出血,脾功能亢进有效控制。结论食管胃底曲张静脉栓塞联合Ⅱ期部分脾动脉栓塞术治疗肝硬化门静脉高压合并上消化道出血,止血效果确切,对于病情重、体质差、肝功能差不耐受外科手术者不失为一种良好的抢救及治疗措施。     

内镜食管静脉套扎联合腹腔镜脾切除术治疗门静脉高压症

目的:探讨内镜食管静脉套扎联合腹腔镜脾切除术治疗门静脉高压症的疗效和安全性、有效性.方法:对48例肝硬化门静脉高压症胃底食管静脉曲张破裂出血及脾功能亢进患者先行内镜下食管曲张静脉套扎术,1～2周后行腹腔镜脾切除术.结果:42例手术成功,6例中转开腹.42例脾切除患者手术时间平均为140 min.术中出血平均为240 mL,术中输血200～600 mL,术后切口愈合良好,无严重术后并发症.48例患者均痊愈出院.结论:对门脉高压症患者,腹腔镜脾切除联合术前内镜套扎术具有微创的优点,安全、有效.     

食管胃底曲张静脉出血诊治进展

门静脉高压症常并发食管胃底曲张静脉出血 (ＥＧＶＢ)、脾功能亢进、腹水、肝性脑病、细菌性腹膜炎和肝功能衰竭等 ,腹水和肝功能衰竭是肝病进展期的标志 ,但最为严重和危急的是ＥＧＶＢ〔1〕。在诊断门静脉高压症时 ,肝功能代偿病人已有 3 0 %出现了食管胃底曲张静脉 ,肝功失代偿者达 60 % 〔2〕。门静脉高压病人有 2 / 3迟早会发生食管胃底静脉曲张 ,其中 2 / 3会发生出血 ,第一次出血时的死亡率达 5 0 % ,生存者又常在 6周内发生再出血 ,使死亡率又增加 3 0 % 〔2 ,3〕。在我国 ,门静脉高压症住院病人在 1990年以后有所增加 ,这与 60～ 7…     

部分脾动脉栓塞术治疗肝硬化门静脉高压症的临床疗效分析

目的探讨部分脾动脉栓塞术（PSE）治疗肝硬化门静脉高压症的临床疗效。方法选取我院62例肝硬化食管胃底静脉曲张破裂出血和脾功能亢进患者。全组均行PSE,观察手术前后外周血象变化,门静脉、脾静脉管径变化及术后并发症发生情况。结果PSE术后白细胞、血小板计数高于术前（P〈0．05）;门静脉、脾静脉管径较术前缩小（P〈0．05）,全组病例无严重并发症发生。结论PSE治疗肝硬化并脾功能亢进操作简便、创伤较小、疗效稳固,可以抢救和预防再出血,尤适用于高危病重、老年不适于手术治疗者,是值得临床推广和应用的手术方法。     

内镜下食管曲张静脉套扎术联合药物治疗肝硬化门静脉高压症食管、胃底曲张静脉破裂出血效果分析

目的 探讨内镜下食管曲张静脉套扎术(EVL)联合药物治疗肝硬化门静脉高压症食管、胃底曲张静脉破裂出血的临床效果.方法 回顾性分析西平县人民医院2016-01—2020-05收治的60例肝硬化门静脉高压症食管、胃底曲张静脉破裂出血患者的临床资料.依据治疗方法分为药物治疗组(对照组,26例)和EVL联合药物治疗组(联合组,...     

Intraoperative coronary venography for portal hemodynamic observation in the procedure of combined portozygos disconnection

Since 1986, intraoperative coronary venography was performed on 24 patients before and after undergoing portoazygos disconnection for portal hypertension. Before the disconnection the portal vein was found to be communicated with cardial and esophageal veins by two pathways, i.e. from the esophageal branches of the coronary vein to the esophageal varices, and from the gastric branches of the coronary vein to the esophageal varices by way of the gastric intramural venula. The portal blood flow was postulated to be hepatofugal because the portal trunk could not be seen on the venography. Coronary venography done after the disconnection found no pericardial and esophageal varices but the portal vein with hepatoportal blood flow. The authors come to the conclusion that the operation has the advantage of both complete disconnection between the portal vein and the cardio-esophageal varices, thus preventing the varices bleeding, and increasing hepatic blood flow.     

手术、内镜下治疗食管胃底静脉曲张出血的近期和远期疗效观察

目的 比较内镜下食管静脉套扎术（EVL）联合硬化剂注射（EVS）和食管胃底静脉断流术对食管胃底静脉曲张破裂出血的近期和远期疗效,探讨EVL结合EVS和两种方法单独应用的适应证。方法12例肝硬化门脉高压症患者行食管胃底静脉断流术,术后胃镜观察曲张静脉消失程度及合并出血的情况,其中6例术后做了EVL或EVS;32例行EVL结合EVS;9例单纯行EVS;5例单纯行EVL。所有病例术后随访3年,观察曲张静脉消失和复发程度以及出血情况。结果 食管胃底静脉断流术为急诊止血的可靠方法,但术后仍存在程度不同的曲张静脉,术后3年内再出血发生率高达66.7％（8/12）,术后择期行EVL或EVS,曲张静脉可完全消退。EVL结合EVS曲张静脉完全消退达93.75％（30/32）,总疗程2-3周。内镜下治疗后3年内观察曲张静脉复发率仅为10.53％（4/38）,再出血发生率为6.52％（3/46）。结论EVL结合EVS对食管胃底静脉曲张破裂出血的近期和远期疗效明显优于手术组。食管胃底静脉断流术后施行EVL和/或EVS可以同时达到降低门脉高压和消除曲张静脉目的。EVL结合EVS明显优于两者单独应用的疗效,同时避免了单纯用EVS容易引起出血的可能性,并且缩短了单纯用EVL的疗程,克服了后期套扎的难度。     

Clinical study of radioisotopic splenoportography in portal hypertension

Radioisotopic splenoportography was performed in 55 patients with portal hypertension, in whom 52 had various degrees of esophagogastric varices, and in 20 patients without portal hypertension. In the patients with varices, collateral images were obtained in 50 patients (96%) by this method and no image was obtained in the patients without varices. The rate of positively imaged collaterals was as follows: Esophageal varices 69%, the left gastric vein 85%, the short gastric veins 48%, RI stasis in esophagogastric region 65%, the azygos vein 46%, the subclavian vein 25%, the para-umbilical veins 46%, splenorenal /gastrorenal shunts 19%, the inferior mesenteric vein 17%, the left intercostal veins 6%, and Arantius's duct 4%. These rates were superior to that obtained from the conventional transarterial portography. There were some correlations between RI-images by this method and clinical and laboratory findings; patients with ascending collaterals alone tended to have extensive and severe varices and higher rate of bleeding, on the other hand, variceal bleeding was not found and episodes of portosystemic encephalopathy frequently occurred in patients with descending collaterals alone. After successful sclerotherapy, RI-images of esophageal varices disappeared in 92% of the patients. Radioisotopic splenoportography appears to be a useful diagnostic and follow-up modality for patients with portal hypertension and esophagogastric varices.     

Azygos venous blood flow in portal hypertension

Azygos venous blood flow estimated by the continuous thermodilution method was measured in 48 patients with portal hypertension. In patients with cirrhosis, azygos venous blood flow was 326 +/- 139ml/min (mean SD) and was significantly higher than in patients without portal hypertension (163 +/- 61ml/min). In patients with idiopathic portal hypertension and extrahepatic portal obstruction, azygos venous blood flow was 411 +/- 227ml/min and 328 +/- 85ml/min respectively. Azygos venous blood flow was significantly correlated with the hepatic venous pressure gradient but neither with cardiac output nor with size of esophageal varices. In eleven cirrhotic patients, azygos venous blood flow and other hemodynamic parameters were measured before and after the nonshunting operation of esophageal transection, splenectomy and esophagogastric devascularization. Azygos venous blood flow and hepatic venous pressure gradient were significantly reduced after operation. On the other hand, cardiac output did not change significantly after surgical procedure. Relatively high postoperative azygos venous blood flow indicates its important role in the postoperative collateral circulation.     

门静脉高压症不同术式对门奇静脉侧支循环的影响

目的评价内镜结扎、断流术与腔内外联合断流对门奇静脉侧支循环的影响。方法 115例患者随机分为内镜结扎组(54例)、断流手术组(30例)、腔内外联合断流组(31例),在治疗前后用微探头超声检查食管下段静脉,彩色多普勒超声检测奇静脉血流动力学各项指标。结果治疗后内镜结扎组食管静脉曲张消失但周围静脉侧支仍存在;断流组食管周围静脉侧支减少但静脉曲张无明显变化;联合组食管静脉曲张和周围静脉侧支均显著减少或消失。3组奇静脉血流量较术前分别下降31％、32％和43％。结论腔内外联合断流较单一的治疗方法能更好地阻断门奇静脉侧支血流。     

Clinical significance of the cine-portogram in patients with portal hypertension

A cine-portogram is a new diagnostic modality in portal system. The main purpose of this study is to assess the clinical significance of cine-portogram in patients with portal hypertension. Portal hemodynamics have been evaluated by cine-portogram in 28 patients with portal hypertension. Portal hemodynamics have been analysed in the following five main diagnostic findings: portal hepatic perfusion, hemodynamics of coronary vein, dominance of gastric vein or short gastric vein, extension of varices in lower esophago-proximal gastric region, and route of draining vein of esophageal varices. The grade of portal hepatic perfusion has been evaluated in all cases by cine-portogram. Hemodynamics of coronary vein have been evaluated in 78% of patients. Dominance of the left gastric vein or short gastric vein has been evaluated in 84% of patients. Extension of varices in lower esophago-proximal gastric lesion and route of draining vein of esophageal varices have been evaluated by only cine-portogram. In conclusion, the cine-portogram is a new and useful diagnostic modality for the evaluation of portal hemodynamics in patients with portal hypertension.     

Hyperdynamic circulation in the left gastric venous area in patients with portal hypertension: angiological assessment

The time of appearance of the left gastric vein on serial celiac arteriograms in patients with portal hypertension and esophageal varices was compared with that of the portal vein to assess regional hemodynamics in the left venous portion of the stomach, an area located in close proximity to the varices. In two thirds of all the patients with cirrhosis or non-cirrhotic idiopathic portal hypertension (IPH), the left gastric vein was visualized earlier or simultaneously than or with the portal vein, while in all but one patient with prehepatic portal obstruction, there was a delayed opacification of the left gastric vein. These results suggest the presence of a hyperdynamic circulatory state which promotes venous hypertension in the left gastric venous area of the stomach of a considerable number of patients with cirrhosis or IPH. In such a hemodynamic state, selective decompression of varices can be achieved by a left gastric venous caval shunt.     

Esophageal varices evaluated by endoscopic ultrasonography: observation of collateral circulation during non-shunting operations

Summary To clarify the inflow and outflow vessels of esophagogastric varices, we investigated the collateral circulation using endoscopic ultrasonography (EUS; Olympus GF-UM2, 7.5 MHz, radial type) during non-shunting operations in 16 cases of portal hypertension. The main inflow vessels were the left gastric veins and the short gastric veins. The paraesophageal vessels coalescent with esophageal varices were distributed up to 7 cm from the esophagogastric junction. It was possible to devascularize these inflow vessels from the transabdominal approach, and it was also easy to evaluate the complete devascularization by the intraoperative EUS. The main outflow vein seemed to be the azygos arch from the investigation of cross-sectional areas of the azygos system. EUS is very useful in evaluating portal hypertension and in determining the indications and the efficacy of the treatment.