经胸门奇静脉断流术的外科解剖学基础(附52例临床疗效分析报告)

观测了１００例成年尸体胃底、贲门及食管区静脉。结果显示：胃左、右静脉的出现率是９６％和９２％，胃小弯侧的静脉分布可归纳为５型：胃左静脉型、胃右静脉型、胃左静脉优势型、胃右静脉优势型和胃左右静脉均衡型。胃后静脉出现率为７３．６％，胃左静脉与左膈下静脉间有相对恒定的吻合，此种情况占４８％。在此基础上作者于１９７６年３月至１９９２年３月对５２例因门脉高压症大出血患者行经胸门奇静脉断流术，急症手术死亡率为４．９％，急症手术止血率为９２．６％，远期再出血率为１１．４％。作者认为彻底断流的关键是识别胃小弯侧静脉分型、胃左静脉汇入部位及属支变化；胃后静脉及门腔吻合。阐述了经胸门奇静脉断流的优越性。

THE SURGICAL AND ANATOMICAL BASES OF TRANSTHORACIC INTERRUPTION OF PORTOAZYGOS CIRCULATION (A REPORT OF 52 CASES)

Anatomical venous distribution around the lower esophagus,gastric cardia and fundus in 100 adut cadavers had been observed. The results showed that the occurrence rates of the left gastric and the right gastric veins were 96% and 92% respectively. Venous distribution in the lesser curvature of the stomach can be classified into five types:the left gastric vein type,the right gastric vein type,the left gastric vein dominant type,the right gastric vein dominant type,and the balance type(of the left and the right gastric veins). The retrogastric veins were found in 73. 6% of 100 cadavers showed portacaval anastomoses. From March 1976 to March 1992,we had treated with transthoracic interruption of portoazygous circulation, 52 cases of portal hypertension resulting in bleeding du to rupture of esophageal and ventriculi fundus varices (male 43, female 9). Among the 41 emergency operations, 2 cases died (4. 9% ), and bleedings were controlled by emergency surgery in 92. 6% of cases. 44 of the 50 cases (88% ) were followed up. The recurrence of bleeding occured in 5 cases,with a long-term bleeding rateof 11. 4%. The authors suggest that anatomical factors might be the reason of inadequacy of portoazygous interruption,and claim the advantages of transthoracic interruption of portoazygous circulation.