门静脉高压症手术后再出血的处理(附43例分析)

<正> 肝硬变引起门静脉高压时,食管曲张静脉破裂所致急性大出血较为常见,需外科治疗。我院自1963年6月至1983年5月,20年来共收治肝硬变食管、胃底曲张静脉破裂大出血281例(包括血吸虫病肝硬变139例,肝炎后肝硬变142例),其中曾经在我院或外

MANAGEMENT OF REBLEEDING AFTER OPERATIN FOR PORTAL HYPERTENSION (Report of 43 Case)

For the past 20 years, 43 cases of rebleeding after operation due to massive hemorrhage of ruptured esophago-gastric fundus varication in portal hypertension were admitted to our hospital. This paper summarizes the management of them. Of the 43 cases, 21 cases were of posthepatitis cirrhosis and 22 cases due to schistomiasis cirrhosis. All the patients were divided into two groups: operative and nonoperative. The results showed that the curative effect of the operative group was better than that of the nonoperative group and that the fatality rate of the cases of schistosomiasis cirrhosis was lower than that of the cases of posthepatitis cirrhosis. Patients with good liver function (Child A or B class) ought to be treated by eaily operation; but if liver function is of Child C Class, we suggest that emergency oppression hemostasis be performed by Sengstaken-Blakemore tube, and operation be performed after improvement of liverfunction. There are disconnection and shunt in surgical treatment of recurrence of bleeding. We consider disconnection must be through and shunt must be effective. Because the requirement of the technical level of shunt is high, it is not extensively performed. However, disconnection operation is simple, with low complication rate, so that it is easily popularized. Most rebleeding patients were operated on many times and had as a result severe adhesion in abdomen. The complications of disconnection by way of pleural cavity are few, its fatality rate is low and its curative effect is satistactory. Therefore the authors consider that this operation procedure is worth doing for emergency patients of rebleeding.,