选择性贲门周围血管离断术与并发症防治

目的：探讨选择性贲门周围血管离断术并发症的发生率及其防治。方法：选择性贲门周围血管离断术96例。其中肝炎后肝硬化76例，胆汁性肝硬化8例，血吸虫病性肝硬化3例，其他类型肝硬化9例。择期手术64例，急诊手术14例，预防性手术18例。结果：术后并发症总体发生率为23．9％。肝功能Child C级、血胆固醇〈3．0mmol／L、总胆红素〉100mmol／L时术后并发症发生率显著升高（P〈0．05）。手术死亡率4．2％，主要死亡原因为上消化道再出血并发肝性脑病、多器官功能衰竭。术后1年、2年及3年再出血率分别为3．1％、6．O％及5．6％。结论：为减少门静脉高压症断流术并发症，应掌握手术适应证，熟练掌握手术要领及围手术期处理。

Complications after selective pericardial devascularization in portal hypertension patients

Objective：To investigate the incidence and prevention of postoperative complication after selective pericardial devascularization for patients with portal hypertension. Methods： Ninety - six patients with portal hypertension were treated by selective pericardial devaseularization. Of the 96 patients, 76 were posthepatitie cirrhosis, 8 were biliary cirrhosis, 3 were sehistosomal cirrhosis, and 9 were agnogenie cirrhosis. Selective operation was performed in 64 patients, emergency operation in 14 patients, prophylactic surgery in 18 patients. Results： The total incidence rate of postoperative complication was 23. 9%. The incidence of postoperative complication was increased significantly in patients with liver function of Child C grade, serum cholesterin 〈 3.0 mmol/L and total bilirubin 〉 100 mmol/L （P 〈0.05 ）. The operative mortality was 4.2% , and the major death cause was recurrent upper gastrointestinal bleeding combined with hepatic encephalopathy and multiple organ dysfunction syndrome. The 1 - , 2 - , 3 - year incidence rates of upper gastrointestinal rehaemorrhagia were 3.1%, 6. 0% and 5. 6%, respectively. Conclusion： For portal hypertension patients, selective pericardial devascularization should be performed according to the inclusive criteria, the specification of the surgical procedures and the principle of perioperative management to avoid the postoperative complications.