预防性断流术治疗肝硬化门静脉高压症的疗效观察

【目的】探讨预防性断流术治疗肝硬化门静脉高压症的临床疗效。【方法】102例肝功能良好的肝硬化门静脉高压症患者，合并食管胃底静脉重度曲张，行预防性断流术65例，药物治疗37例，比较两种方法的临床疗效。【结果】预防性断流组患者无一例死亡，术后腹腔内出血2例，左膈下包裹性积液1例，均行保守治疗后治愈，术后无肝功能衰竭及肝性脑病发生，脾功能亢进消失，随访18个月无上消化道出血病例；药物治疗组随访18个月出现上消化道大出血12例，其中并发肝性脑病2例，死亡2例，脾功能亢进无改善。与药物组相比，手术组食管胃底曲张静脉消失率显著增高，上消化道出血率明显降低，其差异均有统计学意义（P〈0．01）。【结论】对于肝硬化门静脉高压症患者，合理把握手术指征，行预防性断流术，疗效满意，值得临床推广应用。

Observation on the Efficacy of Prophylactic Devascularization for the Treatment of Cirrhosis Portal Hypertension

Objective] To explore the clinical efficacy of prophylactic devascularization on patients with cirrhosis portal hypertension. Methods] Among 102 cases of cirrhosis portal hypertension with good liver function and severe gastroesophageal varices, 65 patients underwent prophylactic devascularization and 37 pa- tients received drug therapy. The clinical efficacy was compared between two methods. Results] No one in prophylactic devascularization group died. Intraperitoneal hemorrhage after operation occurred in 2 patients. Left subphrenic encapsulated effusion was found in one patient. The 3 patients were cured by conservative treatment. No liver function failure and hepatic encephalopathy occurred. Hypersplenism disappeared after op eration. No upper gastrointestinal bleeding was found during 18 months of follow up. In drug therapy group, 12 patients had upper gastrointestinal bleeding including 2 patients complicated with hepatic encephalopathy and 2 dead patients during 18 months of follow up. The patients in drug therapy group had no improvement of hypersplenism. Compared with drug group, the disappearance rate of gastroesophageal varices in prophylactic devascularization group was 96.92 V00, and the incidence of upper gastrointestinal bleeding decreased obviously, and there was significant difference between 2 groups（ P d0.05）. Conclusion] Reasonably mastering the operation indications before prophylactic devasculariztion for patients with cirrhosis portal hypertension can obtain satisfactory efficacy, so it is worthy of clinical promotion.