保脾断流术治疗门静脉高压症食管胃底静脉曲张破裂出血的远期疗效观察

目的探讨保脾断流术治疗门静脉高压症食管胃底静脉曲张破裂出血的远期疗效。方法对我院2008~2013年期间所行的保脾断流术患者进行门诊或者电话随访,观察食管胃底静脉曲张缓解、再出血、生存情况及术后远期并发症。结果共完成保脾断流术治疗门静脉高压症食管胃底静脉曲张破裂出血患者32例,围手术期死亡1例。23例患者获得随访,平均随访时间45.5个月(10~81个月),随访期内有7例发生术后再出血,5例死亡,3例新发门静脉血栓,2例发生食管吻合口狭窄。结论保脾断流术在特定的患者中,是一种有效的治疗门静脉高压症食管胃底静脉曲张破裂出血的术式。     

XF—90消化道残端闭合器在断流术中的应用

用断流术治疗因门脉高压症所致食道胃底静脉曲张,由于彻底离断了贲门周围血管,使食管胃底局部血流减少,曲张静脉压力降低,而门静脉压则更增高,从而保证了入肝门静脉血流的增加,有利于肝细胞功能的改善。手术操作较简单,损伤小,但术后仍有部分患者再出血。再出血的主要原因之一是未能阻断脾胃区经胃壁粘膜下向奇静脉回流的1/8血流,但在结扎离断贲门的周围血流后胃远端的门静脉压升高,会加重食管下端和胃底粘膜下静脉曲张,     

急诊门奇断流术治疗门脉高压食管胃底静脉曲张破裂大出血的疗效分析

目的 总结和分析脾切除加门奇断流对门脉高压食管胃底静脉曲张破裂大出血的疗效.方法 回顾性对比分析2002 年1 月至2006 年3 月间本院急诊门奇断流术29 例和择期门奇断流术20 例的资料,探讨急诊门奇断流术的疗效.结果 本组49 例术后上消化道出血均停止.急诊手术的手术并发症发生率、术后再出血率两组间无显著性差异,但急诊手术的死亡率为6.7%,明显高于择期手术的死亡率0%.结论 急诊脾切除加门奇断流术治疗门静脉高压食管胃底静脉曲张破裂大出血是安全有效的治疗方法,止血效果确切,肝功能衰竭和肝性脑病发生率低.     

胃静脉曲张:指导治疗的建议性分类

胃静脉曲张通常是由全身或区域性门脉高压引起,后者由脾静脉栓塞引起,导致侧支静脉的形成,由胃短静脉和胃壁,经胃左静脉通向门静脉,一股造成胃体和胃底静脉曲张,但无食管静脉曲张.这种静脉曲张出血,可做脾切除治疗,并直接结扎出血静脉.来自全身性门脉高压引起的胃静脉曲张,几乎均伴有食管静脉曲张,通常称胃食管静脉曲张.胃静脉曲张的表现相同,可按食管静脉曲张一样治疗,这是一种误解.不像食管静脉曲张,胃静脉曲张的发生率还不清     

肝硬化门静脉高压合并门静脉血栓行TIPS治疗临床分析

探讨肝硬化门脉高压合并门静脉血栓行TIPS治疗临床效果。选取2020年1月—2021年12月治疗的肝硬化门脉高压合并门静脉血栓患者92例,分为观察组（n=44）和对照组（n=48）,观察组接受TIPS治疗,对照组给予门静脉置管溶栓治疗,观察两组手术时间、手术费用及手术前后肝功能、凝血功能指标,同时分析食管胃底静脉曲张改善、再出血发生、肝性脑病发生、病死率差异。观察组术后门静脉压力梯度明显低于对照组（P<0.05）。观察组术后食管胃底静脉曲张改善优于对照组（P<0.05）,术后食管胃底静脉曲张治疗有效率为84.09%。观察组和对照组再出血发生率、肝性脑病发生率和病死率比较差异无统计学意义（P>0.05）。在肝硬化门脉高压合并门静脉血栓治疗中,TIPS治疗能明显改善门静脉压力水平及食管胃底静脉曲张程度。     

门-奇静脉断流加脾切除术治疗门静脉高压症95例报告

目的 探讨门-奇静脉断流加脾切除术对肝硬化、门静脉高压症导致食管、胃底静脉曲张的治疗效果。方法 回顾性分析95例门-奇静脉断流加脾切除术的临床资料;全组男68例,女27例,均为肝炎后肝硬化,门静脉高压,食管、胃底静脉曲张病例,全部均有脾功能亢进表现,肝功能Child A级62例,Child B级33例。施行Hassab断流加脾切除术29例,施行改良Sugiura式门-奇断流加脾切除术41例,施行选择性改良Sugiura式门-奇断流加脾切除术25例。结果 全组术后均检出白血球升高,血小板计数超300×109/L 25例,术后平稳恢复83例;肝功能明显减退、大量腹水、少尿12例,轻度黄疸2例,经积极治疗全部康复出院。85例（89.5%）得到1～3年随访,在29例Hassab手术中6例再出血（20.6%）;41例改良Sugiura手术中5例再出血（12.19%）,2例为食管静脉曲张出血,3例为门脉高压性胃病引起;25例选择性改良Sugiura手术均无再出血表现。结论 选择性改良Sugiura门-奇静脉断流加脾切除术是现代治疗门静脉高压、食管胃底静脉曲张急性出血的有效手术,在三种断流术中具有合理性和优越性。     

急症门-奇静脉断流加脾切除术30例报告

目的 探讨急症门-奇静脉断流加脾切除术对食管、胃底静脉曲张急性出血的治疗效果.方法 回顾性分析30例急症门-奇静脉断流加脾切除术的临床资料;全组男25例,女5例,均为肝炎后肝硬化、门静脉高压、食管及胃底静脉曲张急性出血病例,全部均有脾功能亢进表现,肝功能Child A级11例,Child B级19例,前20例施行改良Sugiura式门-奇断流加脾切除术治疗,后10例施行选择性改良Sugiura式门-奇断流加脾切除术治疗.结果 全组术后均检出白血球升高,25例血小板计数超300×109/L,25例术后平稳恢复,5例肝功能明显减退,大量腹水、少尿,2例轻度黄疸,经积极治疗全部康复出院.27例(90%)得到1~3年随访,在17例改良Sugiura手术中3例再出血,1例为食管静脉曲张出血,2例为门脉高压性胃病引起,后10例选择性改良Sugiura手术均无再出血表现.结论 改良Sugiura门-奇静脉断流加脾切除术是治疗门静脉高压、食管胃底静脉曲张急性出血的有效手术,选择性改良Sugiura式门-奇断流加脾切除术治疗更有其优越性.     

门静脉高压症原位肝移植前后内脏血流动力学变化的临床研究

目的 研究门静脉高压症原位肝移植前后内脏血流动力学变化及其对脾功能亢进、侧支循环、术后肝功能恢复的影响.方法 2002年6月至2005年10月上海交通大学医学院附属瑞金医院外科共完成173例原位肝移植术.选取其中38例肝硬化门静脉高压症患者,分别于术前、术后1、3、5、7 d、1个月、6个月、1、2、3年行彩色多普勒超声检查,监测患者门静脉血流平均速度、门静脉血流量、肝动脉阻力指数等血流动力学指标和脾脏大小变化,并与8例急性重症肝炎患者及20名健康人进行对照,同时观察其对肝功能和食管胃底曲张静脉的影响.结果 肝硬化门静脉高压症患者术后门静脉血流平均速度从术前(13.7±4.2)cm/s升至(58.4±25.2)cm/s,门静脉血流量从(958±445)ml/min升至(3024±1207)ml/min,肝动脉阻力指数从0.65±0.11升至0.74±0.12,均明显高于急性重症肝炎组和正常对照组(P<0.05),门静脉血流平均速度和门静脉血流量分别于术后6个月、2年降至正常对照组水平.肝硬化门静脉高压症组术后脾功能亢进从术后第2天开始改善,至术后1个月完全恢复,但脾脏肿大在术后3年仍然存在.术后食管胃底曲张静脉亦明显改善.结论 肝硬化门静脉高压症患者原位肝移植术后内脏高血流动力学仍将长期存在,但并不影响脾功能亢进和食管胃底静脉曲张以及肝功能的恢复.     

断流术联合胃底切除治疗门静脉高压症

目的 探讨断流术加食管下端及胃底切除术治疗门静脉高压的疗效.方法 回顾性分析32例采用断流术联合食管下端及胃底切除术治疗门静脉高压症患者(联合组)的临床资料,并以34例贲门周围血管离断术为对照组,患者均为肝炎后肝硬化,均患有明显的食管胃底静脉曲张,且有1次以上出血史.结果 患者均获随访,平均14个月,两组患者术后门静脉压变化及手术近期病死率比较,差异无统计学意义(P>0.05);食管胃底静脉曲张、术后再出血、腹胀和早期胃潴留等联合组明显优于断流组(P<0.05).结论 断流术联合胃底切除治疗门静脉高压症上消化道出血止血确切,复发出血率低,并发症少,是治疗门静脉高压症较理想的一种手术方法.     

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。     

Triplex operation for children with extrahepatic portal hypertension

Background/Purpose: How to deal with the vexatious problem of esophageal and gastric varices secondary to extrahepatic portal hypertension has been discussed extensively among pediatric surgeons around the world. The aim of this study is to evaluate the effect of triplex operation (splenopneumopexy, portal azygous devascularization, and ligation of splenic artery) for children with portal hypertension in the author's hospital. Methods: From March 1993 to November 1998, 7 children with extrahepatic portal hypertension were admitted to the author's hospital to undergo triplex operation. The diagnoses of these patients were confirmed by gastroscopy, barium meal, and Doppler ultrasonography. The number of white blood cells and platelets and the hepatic function were checked before and after operation. And the free portal pressures (FPP) were checked before and after the ligation of the splenic artery. All patients underwent follow-up for 1 to 7 years (mean, 4.6 years). The episodes of upper gastrointestinal bleeding were recorded. The degree of varices of distal esophagus and proximal stomach were assessed by barium meal and gastroscopy. The diameters of the spleenic and portal vein were obtained by B ultrasonography. The portopulmonary shunt and portal blood flow were evaluated by color Doppler flow image (CDFI). The indices of hemorheology such as hematocrit, viscosity of whole blood and plasma, and the indexes of deformability and aggregability of red blood cells were obtained through viscometer (R-20 Seerle, Beijing, China). Results: There was no operative mortality in this group. Postoperatively, hemorrhage from the esophagus and gastric varices was completely controlled. Although the diameter of spleen reduced progressively, no patient's spleen recovered to normal during the follow-up period. The degree of varices was mitigated, and the FPP was decreased significantly to 34.48 [plusmn] 5.71 cm H₂O from the preoperative 42.62 [plusmn] 6.72 cm H₂O (P [lt ] .05). The rate of portal flow also was decreased. The direction of portal vein was bidirection (one part was away from the liver and the other was toward the liver). The numbers of white blood cells and platelets were increased. The viscosities of whole blood and hematocrit also were increased after operation. Conclusion: The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.     

门静脉高压症断流手术方式及其疗效的探讨

目的 评价门静脉高压症断流手术方式及其疗效。方法 对l996年1月--2002年1月我科收治的167例门静脉高压症接受断流手术治疗的患者进行随访，其中肝功能Child A级46例、B级115例和C级6例。结果 本组无手术死亡和近期再出血。术后发生并发症37例，占22％。其中术后胃出血l9例，9例需手术止血。随访132例，平均随访32个月。术后行钡餐和胃镜检查，断流手术后再发静脉曲张的发生率为20％(26／132)。其中接受单纯贲门周围血管离断术的50例，有22例表现为中重度曲张；贲门周围血管离断 食管横断术56例中仅有4例表现为轻度静脉曲张；食管下段 胃近端切除者26例均无再发静脉曲张。结论 断流手术采用单纯贲门周围血管离断术者效果较差，而接受食管下段 胃近端切除术的患者均未再发静脉曲张，提示该术式具有良好的疗效。     

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目的 总结139例采用食管吻合器的断流术经验，并观察治疗门静脉高压症的疗效。方法 对139例肝硬化性门静脉高压症采用食管吻合器的联合断流术治疗。结果 无手术死亡。腹腔内继发性出血2例（1．44％），肺不张和肺部感染各1例（0．72％），脾静脉血栓3例（2．16％），无食管吻合口瘘和吻合口狭窄。肝性脑病发生率0．72％（1／139）；再了血率2．16％（3／139）；手术1－3个月后，97例术前肝功能属Child-Pugh B级者有，76例转为A组；71例于术后半年接受过胃镜或食管吞钡检查，食管胃底曲张静脉消失者43例（60．56％），显著改善者27例（38．03％），无变化者1例（1．41％）。结论 应用食管吻合器的联合断流术治疗肝硬化性门静脉高压症的疗效较好，再出血率低，并发症少，是一种值得推广的治疗门静脉高压症的方法。     

Evaluation of the effectiveness of Dopplerography in patients with diffuse liver disease with portal hypertension syndrome

Under analysis were the results of Dopplerography of the abdominal cavity vessels in 66 patients with liver cirrhosis and 14 patients with the extrahepatic portal block. The sensitivity of the method in diagnostics of the intrahepatic block was 96.9%. The linear rate of the blood flow along the upper mesenterial vein was the most sensitive dopplerographic criterion of liver cirrhosis with the portal hypertension syndrome, the most specific test was the determination of the hepatic artery pulsativity index. A considerable decrease of the index of linear and volume rates of blood flow along the splenic vein and higher index of the splenic artery pulsativity were observed when the functional reserves of the liver decreased. A higher resistance index and the presence of the III degree gastroesophageal anastomoses are characteristic of the patients with bleedings from the veins of the esophagus and stomach.     

自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症

目的 本研究比较自体脾移植联合食管横断吻合术与脾切除联合食管横断吻合术治疗门静脉高压症(PHT)的疗效.方法 将30例研究对象平均分为两组.研究组行脾次全切除加自体脾腹膜后移植及食管横断吻合术;对照组行脾切除加食管横断吻合术.于术前1周及术后6个月通过三维动态增强磁共振血管成像(3D DCE MRA)检测其门静脉主干(MPV)管腔横截面积、血流量、血流速度等门静脉系统血流动力学参数及食管胃底曲张静脉的变化,并观察自体移植脾在腹膜后的侧支血管形成与血流方向的改变.并同步检查血清肝纤维化指标及肝功能的重要指标. 结果术后两组MPV的管腔横截面积、MPV的平均流速和MPV的平均流量均比术前明显减小(P＜0.05).且术后研究组MPV的平均流速和平均流量均少于对照组(P＜0.05).两组手术后胃底曲张静脉、食管曲张静脉均消失或明显改善;两组手术前后肝功能的重要指标均差异无统计学意义(P＞0.05).研究组血清透明质酸水平在术后显著下降(P＜0.05),研究组移植脾成活良好,并建立了广泛的侧支循环. 结论自体脾移植联合食管横断吻合术是一种优于脾切除加断流术治疗肝硬化PHT的方法,且未对肝功能造成负面影响.     

Classification and functional aspects of portal hypertension

Portal hypertension can be classified into two main groups, presinusoidal (intrahepatic and extrahepatic) and intrahepatic.Presinusoidal extrahepatic portal hypertension is unlikely to be associated with hepatocellular failure. Increased splenic flow plays a minor role in its cause. Renal cortical perfusion may be reduced.Causes of presinusoidal intrahepatic portal hypertension include schistosomiasis, myeloproliferative diseases, sarcoidosis, congenital hepatic fibrosis, chronic arsenic poisoning, and primary biliary cirrhosis. Portosystemic shunt operations are well tolerated unless there is associated hepatocellular damage.In cirrhosis, the portal hypertension is presinusoidal, sinusoidal, and postsinusoidal. The problem of bleeding esophageal varices is largely that of hepatocellular failure.The Budd-Chiari (hepatovenous obstruction) syndrome has many causes, including “congenital” webs and trauma. These may be susceptible to a surgical approach.     

Segmental portal hypertension.

Isolated obstruction of the splenic vein leads to segmental portal hypertension, which is a rare form of extrahepatic portal hypertension, but it is important to diagnose, since it can be cured by splenectomy. In a review of the English literature, 209 patients with isolated splenic vein obstruction were found. Pancreatitis caused 65% of the cases and pancreatic neoplasms 18%, whereas the rest was caused by various other diseases. Seventy-two per cent of the patients bled from gastroesophageal varices, and most often the bleeding came from isolated gastric varices. The spleen was enlarged in 71% of the patients. A correct diagnosis in connection with the first episode of bleeding was made in only 49%; 22% were operated on because of gastrointestinal bleeding, but the cause of bleeding was not found. The diagnosis should be suspected in patients with gastroesophageal varices, but without signs of a liver disease, especially if isolated gastric varices are found. The diagnosis is confirmed by portography.     

门静脉高压性脾肿大无外周血细胞减少31例报告

目的:探讨门静脉高压性睥肿大无外周血细胞减少的发生率及其临床意义.方法:回顾性研究门静脉高压性脾肿大336例的临床资料和术中探查的情况.结果:其中31例(9.2%)均有门静脉高压性睥肿大、食管下段胃底静脉曲张和上消化道出血病史及腹水,但无外周血细胞减少.25例获随访,平均WBC、RBC、PLT、Hb术前与术后差异无统计学意义(P>0.05);骨髓极度增生活跃占84%(21/25)、并可见到幼红细胞,增生活跃和明显增生活跃各占8%(2/25),均经手术治疗,术中测量自由门静脉压力平均33.4 cm H2O,脾脏大小平均为23.1 cm × 16.5 cm×9.4 cm.结论:外周血细胞减少是门静脉高压性脾肿大的并发症,而不是其必然表现.对无外周血细胞减少的脾肿大治疗,是否需要切除脾脏值得探讨.     

Sugiura procedure in portal hypertensive children

Bleeding from esophageal varices is an important cause of morbidity and mortality in children with portal hypertension. The treatment protocol is planned according to the etiologic factors underlying the portal hypertension, which may be either intrahepatic or extrahepatic. Although portasystemic venous shunt operations were common previously, they are now regarded as nonphysiologic and are rarely used because of their unexpected results and complications. Today, in many centers, endoscopic procedures have become the first-step treatment modality in bleeding esophageal varices. More complicated surgical procedures, such as devascularization procedures in extrahepatic portal hypertension, and liver transplantation in patients with failing liver, should be performed when conservative measures fail. We followed up 69 patients with portal hypertension with endoscopic sclerotherapy in our department. Here we present a retrospective evaluation of the effect of the Sugiura operation on the prognosis of 12 children (6 with extrahepatic and 6 with intrahepatic portal hypertension) who were not responsive to the sclerotherapy program. No rebleeding was seen in 9 of the 12 (75%) patients after the procedure, and the mortality rate in this series was 1 of 12 (8.3%); this patient died of hepatic failure. Received: November 7, 2000 / Accepted: January 25, 2001     

改良Sugiura手术治疗门静脉高压症的回顾

目的　总结 11年零 5个月采用改良Sugiura手术治疗门静脉高压症的经验 ,评价改良Sugiura手术的优劣。方法　回顾分析 1991年 1月至 2 0 0 2年 6月 ,对 15 4例肝硬化性门静脉高压症施行改良Sug iura手术治疗的结果。结果　手术死亡率为零 ,腹腔内继发性出血 2例 (1.30 % ) ,肺不张和肺部感染各 1例(0 .6 5 % ) ,脾静脉血栓 4例 (2 .6 0 % )。术后随访率 99.35 % (15 3 15 4 ) ,随访时间 5个月 - 11年零 5个月。绝对生存率 98.70 % (15 2 15 4 ) ;肝性脑病发生率 0 .6 5 % (1 15 4 ) ;再出血率 1.95 % (3 15 4 ) ;83例于手术半年后接受过胃镜或食道吞钡检查 ,食管胃底曲张静脉消失者 5 4例 (6 5 .0 6 % ) ,显著改善者 2 8例 (33.74 % ) ,无变化者 1例 (1.2 0 % ) ;6 2例胃镜检查发现有不同程度门脉高压性胃病者 8例 (12 .90 % )。结论　改良Sugiura手术治疗肝硬化性门静脉高压症的疗效优良 ,其再出血率和肝性脑病发生率均很低 ,并发症少 ,手术操作较简单 ,是一种值得和便于推广的门静脉高压症手术方法