门静脉高压症术后再出血的外科治疗

目的 评价外科治疗门静脉高压症术后再出血各种术式的疗效。方法 回顾30年外科治疗门静脉高压373例中术后再出血66斧正临床资料。其中首次手术方式分别有单纯脾切除术、门奇静脉断流术、各类非选择性分流术、联合手术（断流加分流），术后再出血率分别为26.67%、17.86%、14.58%和4.35%，再手术组55例中食管下段胃底切除42例，肠系膜上静脉-下腔静脉分流（MCS）11例，再断流2例，非手术组11例。结果 食管下段胃底切除组手术死亡率9.52%(4/42)，随访平均11年，再出血率9.52%(4.42)，脑病发生率14.29%(6/42)；再断流组2例术后1个月内死亡；MCS组11例无手术死亡，随访平均7.5年，无再出血，脑病发生率9.09%（1/11）；非手术组11例均为门静脉高压性胃病（PHG）。结论 联合手术能有效减少门静脉高压术后再出血，MCS是目前治疗再出血较理想的手术方式。

Surgical treatment of postoperative rebleeding in portal hypertension.

Objective To evaluate the effect of different operative methods for treating rebleeding in patients with portal hypertension(PHT).Methods The clinical data of 66 patients with postoperative rebleeding out of 373 PHT cases during the last 30 years was retrospectively analyzed.Their first operations were splenectomy,portoazygous devascularization,various non selective shunt and combined operation(devascularization combined with shunt),of which,the rebleeding rate were 26\^67%,17\^86%,14\^58% and 4\^35%,respectively.Among 55 cases receiving re operation,there were 42 with distal esophago fundusectomy,11 mesocaval shunt(MCS)and 2 re devascularization.The other 11 cases received nonoperative therapy.Results The mortality,mean follow up time,rebleeding rate and encephalopathy rate were 9\^52%(4/42),11 years,9\^52%(4/42)and 14\^29%(6/42)in distal esophago fundusectomy group;0,7\^5 years,0 and 9\^09%(1/11)in MCS group.All 2 cases in re devascularization group died within one postoperative month.All 11 cases in non operative group were with portal hypertension gastropathy(PHG).Conclusion Combined operation may effectively reduce postoperative rebleeding rate in PHT cases and MCS is a relatively ideal method for treating rebleeding.