脾切除加脾腔静脉分流术治疗门静脉高压症

本院１９７８年～１９９３年以脾切除加脾腔静脉分流术治疗门静脉高压症３１例,报道如下。１．一般资料:本组男２１例,女１０例;年龄１４～６２岁,平均３８．８±９．４岁。均为血吸虫病性肝硬变或混合性肝硬变。肝功能Ｃｈｉｌｄ分级Ａ或Ｂ级。３１例均有轻至重度食管下端静脉曲张,其中２５例有曲张静脉破裂出血史。２．手术方法:全麻或持续硬膜外麻醉。取左上腹旁正中或腹直肌切口。进腹探查肝脏及脾脏,了解脾蒂长度及脾静脉口径,经胃网膜右静脉测量门静脉压。常规切除脾脏,尽量多保留脾静脉。游离胰腺体尾部及胰腺后方之疏松组织(５～６…     

限制性门腔静脉侧侧分流术临床研究

限制性门腔静脉侧侧分流术是在门腔静脉侧侧分流术的基础上,通过对吻合口径的限制,在有效地降低门静脉压力的同时,保持一定的门静脉向肝血流量,维持一定的肠系膜静脉压力,以便在达到迅速、有效、持久地控制出血目的的同时,尽可能减轻对肝细胞功能的损害,减少术后肝性脑病的发生。自从60年代我们提出该术式以来,通过临床和实验研究对该术式进行了不断的完善和改良,并于近年又提出了附加限制环的限制性门腔静脉侧侧分流术以及附加限制环的限制性门腔静脉侧侧分流术加肝动脉强化灌注术,通过努力大大降低了术后脑病的发生率。     

非典型门—体静脉分流术治疗门静脉高压症6例

门-体静脉分流术是治疗门静脉高压症的一种重要外科手段。目前常用的典型术式有门腔静脉、脾肾静脉、脾腔静脉、肠腔静脉吻合术等。但在某些病例,由于这些血管在解剖上的异常或病变所造成的畸形、粘连等,有时会使手术操作遇到很大困难。因此,我们自1984年以来对6例晚期血吸虫病所致门静脉高压症合并反复发生上消化道大出血的病人根据术中具体情     

门腔静脉分流附加肝脏动脉化手术治疗门静脉高压症

门腔静脉分流术是治疗门静脉高压合并食管胃底静脉曲张破裂出血的有效方法,对于降低门静脉压力,防止再出血具有肯定的意义。门腔静脉分流术后,由于肝脏血流减少,术后脑病发生率较高,因此在门腔静脉分流的基础上,附加肝脏动脉化手术来增加肝脏的血流灌注,进而改善肝功能,降低脑病的发生率。我院自1983年1月以来对4例门静脉高压患者,行门腔静脉分流附加肝脏动脉化手术,近期疗效满意,现报告如下。临床资料本组4例均为男性,年龄22～48岁,平均年龄38岁,均系肝炎后肝硬变,合并食管     

经颈静脉肝内门腔静脉分流术治疗肝硬化门静脉高压

报告经颈静脉脉内门腔静脉分流术（TIPSS）6例，成功5例，术后门静脉压力平均下降（1．32±0．24）kPa，食道曲张静脉和其它侧支血管消失，术后1周腹水消退，脾脏缩小，消化道出血得到控制,笔者还就TIPSS的有关技术问题进行了讨论．     

经颈静脉肝内门腔静脉分流术治疗肝硬化门脉高压

目的观察应用经颈静脉肝内门腔静脉分流术（TIPSS）治疗5例肝硬化门脉高压（CPH）的临床结果。方法对5例已确诊的CPH患者行TIPSS治疗，并进行随访观察。全部病例用内镜检查。结果术后平均门脉压由（4．45±0．76）kPa（1kPa＝10．20cmH2O）下降至（2．58±0．55）kPa，病人的主要症状与体征明显改善，随访3－35个月，无一例再出血。1例术后2个月出现轻度肝昏迷，另1例术后3个月出现分流道狭窄，球囊成形后再通。结论TIPSS能安全有效地降低门脉压，控制并预防食管胃底静脉曲张破裂出血，消除腹水。TIPSS远期疗效有待观察。     

经颈内静脉肝内门体分流术治疗门脉高压症

采用经颈内静脉肝内门体分流术（ＴＩＰＳ），对２０例Ｃｈｉｌｄ－Ｐｕｇｈ平均评分为１０．１４±２．３的肝硬变门脉高压症患者进行治疗，成功率９４．１％，分流建立后出血立即停止，门静脉压力下降１．６９±０．７３ｋＰａ，食管曲张静脉和其它侧支血管消失；术后１周脾脏缩小，腹水消退，体重减轻，支撑架内血流速度为７０．１７±２７．６９ｃｍ／ｓ；随访３个月，无出血和腹水复发，支撑架内血流速度７５．００±２３．８５ｃｍ／ｓ。因肝细胞功能衰竭死亡１例，轻度肝性脑病２例。本组资料表明，ＴＩＰＳ对门脉高压症食管静脉曲张出血、腹水的近期疗效显著；而且创伤小，并发症少，有进一步推广应用的价值     

肠腔侧侧分流术治疗门静脉高压症的体会

本文报道了肠系膜上静脉与下腔静脉侧侧分流术7例,并介绍了手术的体会,认为应解剖、暴露肠系膜上静脉“外科干”与相应平面的下腔静脉,清除两者间的增生组织,缩短两者的间距,才易取得手术成功。本术既可使门静脉压下降适中,又对门静脉向肝血流干扰较小,且对组织损伤较轻。     

门腔分流术治疗门脉高压症(附34例分析)

我们于1973年10月～1980年12月应用门腔分流术治疗34例门脉高压症,其中同时脾切除者28例,并用门静脉动脉化者4例,分流前测门静脉压为28～57cm水柱(平均39cm水柱),分流后测门静脉压降低8～36cm水柱(平均降低25cm水柱);13例腹水患者术后迅速消退者12例,3周内消失者1例;33例食道静脉曲张术后全部消失者3(?)例,明显减轻者2例;手术死亡3例,其余31例随访12～78个月,均未发生过再出血和腹水,其中24例于术后3～6个月恢复工作。作者认为:门腔分流同时切脾可降低门脉压、止血、消除脾亢和腹水,为较好的门体分流术。但肝性脑病发生率高(17.6%)。为此,我们采取了六项预防措施,重点在于分流口径应控制在1.0±0.2cm为宜,分流后门脉压维持在17±3cm水柱较好。最后还介绍了门腔分流术同时切脾的手术方法和经验。     

联合分流和断流术治疗门静脉高压症180例

目的 探讨联合分流和断流术治疗门静脉高压症的临床效果.方法 对我院1990年5月至2008年5月采用联合分流和断流手术治疗的180例门静脉高压症病人的临床资料进行回顾性分析.结果 术前自由门静脉压力(FPP)为32.5～35.5 cm H2O(1 cm H2O=0.098 kPa);脾切除、脾腔或肠腔分流术后FPP下降为24 cm H2O;联合手术后FPP平均为24.5 cm H2O.全组无手术死亡,125例随访6个月～7年,复发出血4例,肝性脑病4例,人造血管血栓形成4例,肝功能衰竭死亡2例.结论 联合分流和断流术既保留了断流术的优点,又降低了门静脉的压力,是治疗门静脉高压症的理想术式之一. Abstract： Objective To explore the therapeutic effect of combined splenocaval or mesocaval C shunt and portoazygous deverscularization for the treatment of portal hypertension. Methods The clinical datas of 180 cases of portal hypertension treated with combined procedures from May 1990 to May 2008 in our hospital were analyzed retrospectively. Results The mean free portal pressure was 32.5 -35.5 cm H2O before operation,24 cm H2O and 24.5 cm H2O after splenectomy plus splenocaval or mesocaval C shunt and combined procedure, respectively. There was no death in all patient,6 months - 7 years follow - up of 125 cases showed that 4 cases with rebleeding,4 cases with encephalopathy,4 cases with thrombosis in artificial vascular graft and 2 cases died of liver failure. Conclusions Combined shunt and portoazygous deverscularization not only decreases portal pressure but preserve hepatic blood flow to some extent, it' s one of the best choices for treating portal hypertension.     

门腔分流术后经门静脉输入肝营养因子对肝功能的保护作用

目的 观察肝硬变、门静脉高压症大鼠接受门腔分流手术后,经门静脉输入肝营养因子(促肝细胞生长素、胰岛素)对肝脏功能、病理改变及纤维化程度的影响.方法 肝硬化门静脉高压大鼠随机数字表法分人正常对照组、肝硬变模型组、生理盐水(NS)治疗对照组、促肝细胞生长素(HGF)治疗组、胰岛素(INS)治疗组、促肝细胞生长素+胰岛素(HGF+INS)治疗组.各治疗组大鼠行门腔静脉端侧分流术后给予相应肝细胞营养因子,治疗结束时,取血测定肝功能,取肝组织进行肝硬化分级.结果 血清丙氨酸转氨酶(ALT):HGF治疗组(42.0±9.5)U/L、HGF+INS治疗组(30.1±4.1)U/L明显低于NS组(56.5±12.4)U/L;天门冬氨酸转氨酶(AST):HGF治疗组(172.9±42.8)U/L、HGF+INS治疗组(133.7±21.2)U/L明显低于NS组(266.9±81.5)U/L;血清透明质酸(HA):HGF治疗组(435.4±127.7)μg/L、HGF+INS治疗组(322.5±52.3)μg/L明显低于NS组(563.0±146.4)μg/L,层粘连蛋白(LN)较NS组明显降低(均P＜0.05);各治疗组肝脏纤维化评分、Masson染色胶原沉积面积均较NS治疗对照组明显降低(均P＜0.01).结论 肝硬变大鼠接受门腔分流手术后,经门静脉输入肝营养因子(促肝细胞生长素+胰岛素)可以有效的改善大鼠的肝功能及肝细胞损害,并在一定程度上改善¨静脉高压大鼠的肝脏纤维化程度.     

Reevaluation of limited side-to-side portacaval shunt.

Although the results of limited side-to-side portacaval shunt were better than those of other shunts, postoperative encephalopathy still occurred in 10.2% of the patients. To determine the relationship between the diameter of anastomotic stoma and the development of postoperative encephalopathy, animal experiments and clinical observations were carried out. In 4 of 8 dogs in 3 months after limited side-to-side portacaval shunt and in 6 patients with postoperative encephalopathy, there was significant augmentation of the diameter of anastomotic stoma. To prevent the widening of anastomotic stoma caused by blood flow under high pressure, a limiting ring of 10 mm in diameter was put around the anastomotic site during operation in 21 patients with portal hypertension. Follow-up for 3-15 months (average 6 months) showed that there was no evidence of postoperative encephalopathy and rebleeding. A ring of same kind was put around the dilated anastomotic stoma during exploration in the 6 patients, and all their cerebral symptoms and signs disappeared completely soon after the second operation.

     

肠腔侧侧分流术治疗门静脉高压症的临床研究

目的 探讨小口径肠腔侧侧分流术（ＭＣＳ－ＳＳ）治疗门静脉高压症的可行性。方法 将ＭＣＳ－ＳＳ的吻合口径控制在６～８ｍｍ,并观察了自由门静脉压（ＦＰＰ）、吻合口分流率（ＰＳＳａ）、门静脉向肝血流灌注（ＰＶＦ）及动脉血酮体比值（ＡＫＢＲ）等指标。结果 分流术后ＰＶＦ、ＡＫＢＲ、ＦＰＰ等均显著下降,但小口径组降幅明显小于对照组,ＰＳＳａ也明显低于对照组,而止血效果较对照组却无显著差别。结论 小口径ＭＣＳ     

分流加断流联合手术治疗门静脉高压症58例

目的:探索脾切除、门奇断流附加小口径脾腔静脉分流术治疗门静脉高压症的临床效果。方法:采用脾切除、门奇断流附加小口径脾腔静脉分流术治疗的58例门静脉高压症。结果:58例均为择期手术,术前及术后自由门静脉压力分别为(39.83±3.86)cmcmH2O和(34.42±3.51)cmH2O,随访3月至7年,术后发生肝性脑病3例,再出血1例,腹水消退或好转率87.5%,曲张静脉消失或减轻率89.6%。结论:脾切除、门奇断流附加小口径脾腔静脉分流术是治疗肝硬化门静脉高压症的首选术式。     

Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

Background:

The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension.

Methods:

All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges.

Results:

The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] = 7.45, 95% confidence interval[CI]: (3.93–14.15), P < 0.00001), the same outcomes were seen in shunt stenosis (OR = 20.01, 95% CI: (6.67–59.99), P < 0.000001) and in hepatic encephalopathy (OR = 2.50, 95% CI: (1.63–3.84), P < 0.0001). Significantly better 2-year survival (OR = 0.66; 95% CI: (0.44–0.98), P = 0.04) and 5-year survival (OR = 0.44; 95% CI: (0.30–0.66), P < 0.00001) were seen in patients undergoing surgical shunting compared with TIPS.

Conclusions:

Compared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS.     

门静脉高压患者脾切除术后发热原因的探讨及处理

目的探讨门静脉高压患者脾切除术后发热原因及处理方法。方法对1995年8月~2005年6月本院收治的肝硬化门静脉高压患者脾切除术后发热28例(术后体温>38.4℃,持续性发热2周以上者)临床资料进行回顾性总结分析。结果术后发热可由各种并发症引起,以门脾静脉血栓形成和脾窝积血积液合并感染最为常见,有时无原因。持续性发热与肝功能分级显著相关(P<0.01)。结论门脾静脉血栓形成和脾窝积血积液合并感染是术后持续发热的主要原因.防止各种感染及改善肝功能可有效减少术后持续发热。     

不同术式治疗门静脉 高压合并出血的疗效对比观察

目的 评价不同术式治疗门静脉高压合并出血的疗效。方法 ３６例脾肾分流加断流术（联合手术），３０例离断术（Ｈａｓｓａｂ）和８例远端脾肾分流术（ＤＳＲＳ）前瞻对照，观察临床疗效及门静脉系血流动力学变化。结果 联合手术组术后门静脉压力（ＦＰＰ）平均下降０．６５ｋＰａ，门静脉血流量（ＰＶＦ）平均下降２９３．７２ｍｌ／ｍｉｎ，结果优于Ｈａｄｄａｂ术后ＦＰＰ（下降０．４１ｋＰａ）和ＰＶＦ（下降１８９．０２ｍｌ     

门腔静脉分流术对肝硬变门静脉高压大鼠胃粘膜的影响

目的：胃粘膜病变是门脉高压人上消化道了的主要原因，而门脉分流术（ＰＣＳ）又是治疗门静脉高压症的常用术式，本实验旨在观察ＰＣＳ术后胃粘膜的功能改变，方法：化学方法诱导大鼠肝硬变门脉高压模型，并分成正常组，术前及术后组，观察ＰＣＳ术后门脉压力（ＦＰＰ）胃粘膜血流量（ＧＭＢＦ）粘膜内前列腺素（ＰＧＳ）糖蛋白（ＧＰ）的含量等，统计学处理为方差分析及ｔ检验，结果：肝硬变门脉高压大鼠ＦＰＰ明显高于正常组（１．