分流断流联合术治疗门静脉高压症出血的疗效分析

目的：评估分流断流联合术治疗门静脉高压症食管胃底曲张静脉破裂出血的疗效。方法：将83例分流断流联合术与235例采用其他手术方式的治疗结果进行回顾性对比总结分析。结果：分流组、分流断流联合组术后并发症发生率显著高于断流组(P＜0.05)。断流组远期再出血率显著高于分流组及分流断流联合组(P＜0.05)。断流组无肝性脑病发生，分流组、分流断流联合组发生率分别为12.8％、11.4％。分流断流联合术对门静脉系统血流动力学的影响、手术并发症及肝性脑病发生率等与分流术比较均无显著性差异。术后l，3，5年生存率三组无显著性差异。结论：手术方式的选择应根据各方面因素综合考虑。

THERAPEUTIC EFFECTS OF COMBINED PORTOSYSTEMIC SHUNT AND PORTAAZYGOUS DEVASCULARIZATION ON BLEEDING ESOPHAGEAL VARICES OF PORTAL HYPERTENSION

Objective:To evaluate the therapeutic effect of combined shunt and portaazygous devascularization (SPAD) on bleeding esophageal varices in patients with portal hypertension. Method:Retrospecttive analysis was made on 318 patients with portal hypertension undergoing different types of operation from 1986 to 2001. Results:The rate of operative complications in portosystemic shunt (PSS) group and SPAD group was higher than that in portaazygous devascularization (PAD) group ( P <0.05 ). Long-term postoperative bleeding rate in PAD group was higher than in PSS group and SPAD group( P <0.05). Postoperative hepatic encephalopathy rate in PSS group and SPAD group were 12.8% and 11.4% respectively. There was no significant difference between the three groups in one,three and five years survival rate.In postoperative hemodynamic changes, the rate of operative complications and postoperative hepatic encephalopathy, there was no significant difference between SPAD group and PSS group.Conclusion:Treatment principle to portal hypertension should include operation,postoperative drug therapy of protecting hepatic function and reducing portal pressure. Surgery treatment should be arranged individually for each patient.