脾肾分流加联合断流术治疗门脉高压症的临床研究

目的:探讨提高肝硬化门静脉高压症疗效的术式。方法:采用脾肾分流加联合断流术即脾切除,脾肾分流,胃底、贲门周围血管离断,食道下段离断吻合术治疗门脉高压症患者40例。术中连续监测自由门静脉压力(FPP)的动态变化。术后随访32例,随访时间6-60个月。结果:随访的32例患者,再出血2例,术后死亡3例,1例死于术后近期肝、肾功能衰竭,1例于术后36个月死于肝癌,1例手术后42个月死于上消化道大出血。食道下端吻合口瘘1例,吻合口狭窄1例,肝性脑病2例。术后3-6个月行食道钡餐检查,食道静脉曲张消失或基本消失26例,明显好转6例;彩色多普检查均显示门静脉向肝血流,脾肾吻合通畅,无血栓形成。20例术前有腹水,其中2例术前有大量腹水,13例术后三个月左右腹水消失,4例术后6个月腹水基本消失,3例术后仍少中~量腹水。结论:脾肾分流加联合断流术治疗门脉高压症既保留了分流术和断流术二者的优点,又克服了二者的缺点,而且联合断流术使断流更加彻底。

The Clinical Significance of Splenorenal Shunt CombingDebascularization in Portal Hypertension

Objective:To explore the operative methods for improving the curative effects of portal hypertension.Methods:Foty portal hypertension patients were treated with combined devascularization and splenorenal shunt conbing devascularization(i.e splenectomy,splenorenal shunt,portag-azygous vein devascularization and esophageal transection).Free portal pressure(FPP)was continually monitored during operation,Thirty-two patients were followed-up about 6~60 months.Result:Two patients were rebleeding,Three died after operation;one of three died of hepatorenal failure;one died of hepato-cancinoma 36 months later;one died of upper-gastric hemorrage at 42 monghs later.Esophageal anostomasio fistula happened in one patient.Another patient had esothageal stenosis.The upper-gastric bariun meal done at 3~6 months after operation showed varices in esophagus total or almost total disappered in twenry-six,remarking disappered in six patients.Doppoer shows the blood flow in portal vein toward liver,splenrenal shunt persistence and no thrombosis forming.Twenty ptients had ascites before operation,two of them had huge amount.About three months arter operation thirteen of their ascites disappered.Four of their ascites almost disappered 6 months arter operation.Only three of them had little or medium amount of ascites.Conclusion:Splenorenal shunt combing devascularization not only keeps the advantage of the shunt and devascularization operation but also overcomes both of their disadvantage.The shunt combing devasculariztion had ever more thoroughly effects.