门静脉高压症的外科治疗

我国的乙型肝炎、血吸虫病发病率较高,因而门静脉高压症的发病率明显高于欧美等发达国家。故在我国对此病的预防和治疗更具有深远意义。传统的门静脉高压症的外科治疗主要有断流术和门体静脉分流术2大类。断流术是一类相对简便的手术,不足之处在于围手术期病死率达10%~20%,术后再出血率明显高于分流手术。门腔静脉侧侧分流加肝动脉强化灌注术联合术式,既能保持一定的门静脉向肝血供和提高肝动脉对肝脏的供氧量,又能疏通门静脉系统的高血流状态,故其术后并发症发生率、手术死亡率和再出血率均有明显下降,疗效好。肝移植手术的出现,对彻底治愈肝硬变门静脉高压症带来了希望。但对我国大量肝炎后肝硬变、血吸虫性肝硬变并发门静脉高压症、食管胃底静脉曲张破裂出血的患者,不可能全都采用肝移植治疗。因此,传统疗法在较长时间内仍然会有用武之地。另外,肝移植术治疗费用过高。将大量的资金用于肝移植的研究还是用于病毒性肝炎、血吸虫病的防治,确实是一个值得认真探讨的课题。

Surgical Treatments on Portal Hypertension

The incidence of hepatitis B and schistosomiasis is higher in China, as a result the incidence of portal hypertension in China is significantly higher than it in Europe and USA. It is very important to prevent and treat the portal hypertension in China. Traditional surgical treatments on portal hypertension include devascularization and shunt procedure. The devascularization is a relatively simpler surgical procedure. Its disadvantages include higher perioperative death(10%~20%) and higher recurrent bleeding rate(significantly higher than shunt procedure). The portacaval shunt plus enhancement of perfusion of hepatic artery can increase the perfusion of hepatic artery, maintain the liver function and overcome the side effects of the portacaval shunt. The liver transplantation is the only curative method for the liver cirrhosis and portal hypertension, but in our country it is not impractical to treat all patients with portal hypertension and variceal bleeding of esophago-fundus of stomach resulting from the posthepatitic cirrhosis and the schistosomiasis using liver transplantation. The traditional surgical treatments in China still play an important role in a long term in the future. The higher cost of liver transplantation is also a bigger problem. It should be seriously studied the investing more money for developing liver transplantation or for preventing and treating hepatitis and schistosomiasis.