门-奇静脉断流加脾切除术治疗门静脉高压症95例报告

目的 探讨门-奇静脉断流加脾切除术对肝硬化、门静脉高压症导致食管、胃底静脉曲张的治疗效果。方法 回顾性分析95例门-奇静脉断流加脾切除术的临床资料；全组男68例，女27例，均为肝炎后肝硬化，门静脉高压，食管、胃底静脉曲张病例，全部均有脾功能亢进表现，肝功能Child A级62例，Child B级33例。施行Hassab断流加脾切除术29例，施行改良Sugiura式门-奇断流加脾切除术41例，施行选择性改良Sugiura式门-奇断流加脾切除术25例。结果 全组术后均检出白血球升高，血小板计数超300×109/L 25例，术后平稳恢复83例；肝功能明显减退、大量腹水、少尿12例，轻度黄疸2例，经积极治疗全部康复出院。85例（89.5%）得到1～3年随访，在29例Hassab手术中6例再出血（20.6%）；41例改良Sugiura手术中5例再出血（12.19%），2例为食管静脉曲张出血，3例为门脉高压性胃病引起；25例选择性改良Sugiura手术均无再出血表现。结论 选择性改良Sugiura门-奇静脉断流加脾切除术是现代治疗门静脉高压、食管胃底静脉曲张急性出血的有效手术，在三种断流术中具有合理性和优越性。

Porta-azygous veins disconnection plus splenectomy to treat portal hypertension in 95 cases

Objective To explore the therapeutic effect of porta-azygous vascular disconnection plus splenectomy for the treatment of portal hypertension. Methods Clinical data of 95 patients with porta-azygous veins disconnection plus splenectomy for portal hypertension were analyzed retrospectively. All patients were post-hepatitis cirrhosis and all had hypersplenism. Sixty-two cases had Child A liver function and Child B in 33 cases. Hassab operation was performed in 29 cases, modified Sugiura operation in 41 cases and selective Sugiura operation in 25 cases. Results There were smooth recovered in 83 cases after postoperation. Liver disfunction with ascites and oliguria was found in 12 cases, light jaundice in 2 cases and all cases were recovered through vigorous treatment. Eighty-five cases (89.5%) were followed up for 1~3 years, among 29 cases of Hassab operation, postoperative rebleeding occurred in 6 cases (20.6%); in 41 cases of modified Sugiura operations, postoperative rebleeding occurred in 5 cases (12.19%) and among 25 cases of selective Sugiura operations, no rebleeding case was found. Conclusion Selective modified Sugiura porta-azygous vein disconnection operation plus splenectomy is more superiority for acute bleeding of easophegous and gastric found us varioces.