门静脉高压症并发上消化道出血的急诊手术治疗

目的 总结１９９１．８～１９９９．８共８年来我院１８例行急诊手术治疗的食管及胃底曲张静脉破裂大出血病例，以探讨适宜的手术适应证及手术方法。方法 将１８例病人归纳为急诊分流术治疗组（１１例）及急认充术治疗组（７组）。对比组病从的术前肝功能分级，手术前后门静脉压变化情况，手术死亡率，术后并发症发生率及手术止血率。结果 分流组术前肝功能分级为ＣｈｉｌｄＣ级者占６３．６％（７例），断流术组为４３．９％（３

EMERGENT SURGICAL THERAPY FOR ACUTE GASTRAESOPHAGEAL VARICEAL BLEEDING ON CIRRHOTIC PATIENTS

Objective To evaluate the value of emergent surgical therapy for acute continuous gastroesophageal vaciceal bleeding in cirrhotic patients.Methods 18 cases were divided into two groups,treated with portosystemic shunt(PSS) in group A(11cases),and gastroesophageal devascularization( GED) in group B (7cases).Hepatic function tests,changes in portal pressure pre-and post-operation,mortality and morbidity,bleeding recurrence were compared between the two groups.Results 7cases (63.6%) in group A were of Child C,and 3(43.9%) in group B were of Child C.Bleeding stopped in all patients postoperatively in 2 groups.In group A there was recurrent bleeding in 1 case and postoperative encephalopathy in 3 cases.In-hospiotal mortality was 36.4%(4cases).In group B there was no mortality ,and recurrent bleeding developed in 2 cases which was successfully controlled by conservative therapy.Conclusion Despite a variety of modern conservative therapies including emergent endoscopic ligation and sclerotherapy ,many cirrhotic patients still die of intractable persistent variceal bleeding.Our experience shows that emergent surgical therapy when used properly and in time could remain a therapy of choice.GED which renders less severe burden to the already deteriorated liver function in cirrhotic patients often gives a satisfactory result in terms of hematostasis and acceptable mortality and morbidity when compared with PSS.