门静脉高压症治疗的50年回顾

目的：探讨门静脉高压症的外科治疗。方法：我院50年共收治门静脉高压症939例，分别行脾切除236例，脾腔分流术151例，脾切除＋肠系膜上静脉上静脉下腔静脉吻合术71例，脾肾静脉吻合术42例，肠系膜下静脉下腔静脉吻合术2例，贲门胃底血管离断术409例，胃底曲张静脉和部分脾介入栓塞术28例。术后随访2年、5年，并行上消化道钡餐透视。结果：比较脾腔分流术、贲门胃底血管离断术及胃底曲张静脉和部分脾介入栓塞术的远期效果：脾腔分流术的2年、5年绝对生存率分别为81．6％、56．1％，再出血率4．3％。贲门周围胃底血管离断术的2年绝对生存率为78．7％，再出血率8．0％；5年绝对生存率为74．8％，再出血率为12．4％。胃底曲张静脉和部分脾介入栓塞术的即时止血效果达到100％，术后2年再出血率为率28．6％，死亡率14．3％，术后5年生存率为14．3％。结论：Child分级B级，特别是已发生过大出血的病人，可选择贲门周围胃底血管离断术。ChildC级、有严重黄疸、腹水，发生大出血不宜手术治疗的病人，可行介入曲张血管栓塞术治疗。

Fifty-year Experience in the Treatment of Portal Hypertension

To discu ss the appropriate treatment of portal hypertension. Methods: N ine hundred and thirty-nine patients w ith portal hypertension were treated in t he past 50 years: Splenectomy, 236 cas es; splenocaval shunt, 151 cases, splenect omy+SMV-IVC shunt 71 cases, splenoren al shunt 42 cases, IMV-IVC shunts 2 cases ; pericardial and fundic devasculariza tion 409 cases; interventional embolizatio n of varicose veins 28 cases. The pat ients were followed up for 2 years and 5 ye ars after operation and were examine d by upper GI barium meal-fluoroscopy. Results: Comparison wa s made between the patients having undergone splenocaval shunt, pericardial and fundic devascularization and interventional embolization of varicose veins the 2-year and 5-year absolute survival rate after splenocaval shunt were 8 1.6% and 56.1% respectively, rebleeding rate being 4.3%.For cases with pe ricardial and fundic devascularization, the 2 -year absolute survival rate and r ebleeding rate were78.7% and 8.0%, and those after 5-year were 4.8% and 2.4% respectively. For the cases submitted to interventional embolization of th e varicose veins, the immediate rate of hemost asis was 100%, the 2-year rebleed ing rate and mortality rate were 28.6% and 14.3%, the survival rate being 1 4.3%. Conclusions: For Child B cases, especially those with ma ssive bleeding, pericardial and fundic devascula rization is preferred. For Chil d C cases with severe jaundice and ascites, confr onted with massive hemorrhage, and contra-indicated for operation, intervention al embolization of the varicos e veins is the method of choice.