急诊与择期门奇断流治疗食管胃底静脉曲张破裂大出血

目的总结和分析肝硬化门脉高压上消化道大出血行脾切除加门奇断流术的疗效。方法对我院2000年1月至2006年12月间择期门奇断流术46例和急诊门奇断流术21例的临床资料进行回顾性分析。结果本组67例术后上消化道出血均停止。急诊手术的手术并发症发生率、术后再出血率两组间差异无统计学意义,但急诊手术对术后肝脏功能有一定影响。结论脾切除加门奇断流术治疗门静脉高压食管胃底静脉曲张破裂大出血是安全有效的治疗方法,止血效果确切、手术时机的把握和围术期处理是急诊手术成功的关键。

Efficiency of emergent and selective portal-azygous disconnection with splenectomy for portal hypertention with acute massive hemorrhage

Objective To summarize the curative effect of emergent portal-azygous disconnection with splenectomy for treating the hepatocirrhosis portal hypertention with massive hemorrhage due to esophageal varicose vein and varices of fundus of stomach.Methods A retrospective analysis was made on the results of 67 patients with hepatocirrhosis,portal hypertension who were treated with portal-azygous disconnection with splenectomy from Jan.2000 to Dec.2006.Twenty-one cases were treated with emergency operation,the others were treated with selective operation.Results Upper digestive tract bleeding was controlled by portal-azygous disconnection with splenectomy in all patients.There were no significant difference between the two groups in incidence of postoperative,complications and rehemorrhage.But there were some influence on hepatic function in emergency group.Conclusion Portal-azygous disconnection with splenectomy for treating the hepatocirrhosis portal hypertention with acute massive hemorrhage is a safe and effective procedure.Select of surgery opportunity and management in perioperative period are the key facters in the treatment for the patients with hepatocirrhosis,portal hypertension with acute massive upper digestive tract hemorrhage.