外科治疗门静脉高压症术中肝功能再评价的意义--146例治疗经验小结

目的：探讨外科治疗门静脉高压症术中肝功能再评价对术式选择及其疗效的意义。方法：回顾性总结10年间手术治疗门静脉高压症146例。其中肝炎后肝硬化l18例，血吸虫性肝硬化6例，酒精性肝硬化l例，混合性肝硬化5例，其它原因16例。按Chind分级标准，术前肝功能评价A级45例，B级92例，C级9例。术中肝功能再评价(腹水量，肝脏萎缩程度)：A级33例，B级78例，C级35例。本组断流术89例(61．0％)，各种分流术57例(39．0％)；其中包括预防性手术27例(18．5％)，急诊断流术2例(1．4％)。结果：手术死亡l例(0．7％)，死亡原因为上消化道出血。术后早期出血9例(6．1％)。断流术5例，分流术4例；术后早期脑病2例(1．4％)，断流术、分流术各l例。随访98例，随访率67．6％。其中分流术37例，断流术6l例。随访时间6月～9年。远期再出血12例(12．2％)；其中分流术3例，断流术9例，发生时间平均在术后17月(4～41月)；远期脑病6例(6．1％)，均是分流术病例，发生时间平均在术后19月(3～40月)。分流术组与断流术组的远期再出血率分别为8．1％(3／37)，14．9％(9／61)，P＞0．05；脑病发生率分别为16.2％(6／37)，0％(0／61)，P＜0．0l。死亡8例(5．5％)，死亡原因：上消化道出血2例，肝功能衰竭3例，肝癌2例，直肠癌1例。结论：肝功能储备与门静脉高压症的手术成败及其治疗效果直接相关，术中肝功能再评价对治疗门静脉高压症的术式选择有指导意义。根据病人的肝功能储备、解剖条件以及术者的经验，合理地选择术式，有助于提高手术疗效。

INTRAOPERATIVE REASSESSMENT OF LIVER FUNCTION OF SURGICAL TREATMENT FOR PORTAL HYPERTENSION

Objective:To evaluate the significance of intraoperative reassessment of liver functional reserve for the selection of surgical procedures in treating portal hypertension.Methods:The data of 146 patients with portal hypertension treated by operation in our hospital were analyzed retrospectively. They were Child A 45 cases; B 92 cases and C 9 cases. At intraoperative reassessment they were modified to Class A 33 cases; Class B 78 cases and Class C 35 cases according to the amount of ascites and extent of liver atrophy. Of these patients, 89(61%) were treated with disconnection and 57(39%) with different types of shunts. A prophylactic operation was done in 27(16.4%) and emergency disconnection in 2(1.4%) patients. Result:Early rebleeding occurred in 9 (6.1%), 5 after disconnection and 4 after shunting; early hepatic encephalopathy occurred in 2 (1.4%), one case each for disconnection and shunting. Late recurrence of hemorrhage occurred in 12(12.2%), 9 after disconnection and 3 after shunting; late hepatic encephalopathy occurred in 6(6.1%) and were all after shunting. Operative mortality was 0.7%. Conclusion:The outcome of operation is related to a patient's liver functional reserve. If the operative procedure is selected according to a patient's hepatic functional reserve assessed at operation, local anatomical conditions and experience of the surgeon,the results of surgical treatment of portal hypertension would be much enhanced.