改良Sugiura术治疗肝硬化门静脉高压症

目的:探讨选择性门奇静脉断流联合食管下段横断吻合术在门静脉高压症食管胃底静脉曲张出血的治疗效果。方法:对30例门静脉高压症患者进行选择性门奇静脉断流联合胃肠吻合器食管下段横断吻合术治疗。结果:住院期间无消化道再出血。1例术后胃吻合口出血,继之出现胃吻合口瘘;2例左侧胸腔积液。术后多次胃镜或上消化道造影复查食管中下段及胃底曲张静脉由术前中、重度逐渐好转直至消失,24例患者在术后0.5～1年均恢复不同程度的体力劳动能力。结论:选择性门奇静脉断流联合胃肠吻合器食管下段横断吻合术能有效地防治门静脉高压症食管、胃底静脉曲张破裂出血。

Modified Sugiura procedure for treatment of liver cirrhosis with portal hypertension

Objective:To observe the therapeutic effects by selective portal-azygos vein disconnection and the lower esophagus transection for portal hypertension and gastric variceal hemorrhage.Methods:Thirty patients underwent surgical procedure for portal hypertension by selective portal-azygos vein disconnection and lower esophagus transection with gastrointestinal stapler.Results:Generally,no gastrointestinal re-bleeding in patients occurred in their hospital stay.Yet postoperative gastric anastomotic hemorrhage occurred in one case,followed by gastroesophageal anastomotic fistula,and left-sided pleural effusion in another 2.Repeated gastroscopy or upper gastrointestinal radiography suggested that the lesion in the middle and lower segment of esophagus and gastric varices recovered from the preoperative moderate or severe condition to total disappearance.Twenty-four patients recovered to physical labor to a certain degree within from half to one year after operation.Conclusion:Selective portal-azygos vein disconnection and lower esophagus transection with stapler can effectively prevent the variceal bleeding at esophagus and gastric fundus from portal hypertension.