胆石症致门脉高压症手术时机和手术方式的选择

目的 :探讨胆石症所致的门脉高压症手术时机和手术方式对患者预后的影响。方法 :对二家医院 10年间收治的 36例胆石症门脉高压症患者 ,根据Child分级的在不同的时间选择不同的手术方式进行手术或介入治疗。结果 :肝功ChildA级的患者 ,无论行一期分流或断流均有较好的结局 ;ChildB级根据不同病情选择不同的手术时机和方式 ,仍可以达到较满意的效果 ;ChildC级的患者 ,即使行简单的外引流或二期手术 ,仍有半数以上的死亡率 ;结论 :胆石症性门脉高压与门脉高压性胆石症是二个完全不同的概念 ;在胆石症 -胆道梗道-肝纤维化 -胆汁性肝硬化 -门脉高压症这一疾病发展的不同环节上 ,ChildA级的患者宜采用一期、根治性的手术 ;ChildB和ChildC级的患者 ,应遵循“个体化治疗”的原则 ,以胆石症治疗为重点 ,尽可能缩小手术范围和创伤 ;此类患者术后 1周内肝功能明显较术前恶化 ,必须给予高度的重视和充分的维护 ;术中使用生长抑素和术后使用糖皮质激素可有效地减少术中出血并有利于术后肝功的恢复

CHOICE OF THE OPPORTUNITY AND MOTHED OF OPERATION OF CHOLELITHIASIVE PORTAL HYPERTENSION

Objective:The article sums up the treatment experience of 36cases of cholelithiasive portal hypertension in two hospitals from 1989 to 1999. Cholelithiasive portal hypertension has different conception of portal hypertension clolelithiasis. There are very obvious differences in pathogenesis, clinical diagnosis, therapy and prognosis. Cholelithiasis portal hypertension should be treated as severe disease. There are different methods and results of operation in the different stages of the disease from cholelithiasis, hepatic fibrosis, biliary cirrhosis to portal hypertension. The patients of Child A liver function should be adopted radical operation and those of Child B and C should be adhered to the personnel therapeutic principle. The emphasis of therapy is cholelithiasis and narrowing down the scope of operation and trauma. If patients' liver function get worse in a week after operation, they should be given highly attention and abundantly treatment.Somatostatin used in operation can effectively reduce bleeding and glucocorticiod used after operation can benefit to the restoration of liver function.