贲门周围血管离断术治疗肝硬化门脉高压症围手术期处理体会

目的探讨贲门周围血管离断术治疗肝硬化门脉高压症围手术期处理。方法回顾分析2006年1月~2012年12月112例肝硬化门脉高压症病人行贲门周围血管离断术的围手术期处理。结果本组围手术期无死亡病例,无肝性脑病发生。术后腹腔出血7例(占6.3%),再手术止血5例,2例保守治疗出血停止。门静脉血栓形成3例(占2.7%),经抗凝溶栓治疗后血栓溶解吸收。结论贲门周围血管离断术治疗肝硬化门脉高压症围手术期处理主要措施是术前肝功能评估、术前术后肝功的改善和维护;纠正和处理凝血功能障碍、重度血小板减少;术后门静脉血栓的有效防治在于方法早期诊断以及抗凝处理;合并胆囊结石肝功能Child-Pugh A级,可行断流术加胆囊切除。

The perioperative management of pericardial devascularization for treatment of the patient with liver cirrhosis and portal hypertension

Objective TO explore the perioperative management of pericardial devascularization for treatment of the patient with liver cirrhosis and portal hypertension. Methods Retrospectively analyze 112 cases of liver cirrhosis and portal hypertension undergoing pericardial devascularization in the perioperative period from January 2006 to December 2012. Results The group through active perioperative management caused no death and no hepatic encephalopathy, only 7 cases of which brought up postoperative intra - abdominal hemorrhage, 5 cases stopped bleeding through reoperation ,2 cases stopped bleeding through conservative treatment, 3 cases formed portal vein thrombosis（ blood clots gradually dissolved and absorpted through thrombolytic therapy. The cases of liver cirrhosis and portal hypertension with gallstones did not appear serious complications after pericardial devascularization plus cholecystectomy. Conclusions Preoperative assessment and protection of liver function with postoperative further improvement and maintenance of liver function is the key measure to promote the patient recover well and aviod liver failure. Coagulopathy and thrombocytopenia are the risk factors of postoperative intra-abdominal hemorrhage and should be corrected and treated in the preoperative period. Early diagnosis and anticoagulation are the effective methods to prevent postoperative portal thrombosis, pericardial devascularization plus cholecystectomy can be carried out towards the patients with Child-Pugh A class of iver cirrhosis and portal hypertension with gallstones.