断流术与分流术在门静脉高压治疗的比较

目的探讨分流术与脾切除及贲门周围血管离断术对门静脉高压症的治疗作用。方法回顾该院从2005年6月至2012年6月共113例采用脾切除及贲门周围血管离断术与分流术治疗门脉高压症患者的临床资料,分析手术前后患者脾功能亢进症状、肝功能、食管胃底静脉曲张等情况,比较两者的手术死亡率及术后再出血、肝性脑病和门静脉血栓的发生率。结果治疗后两组患者自由门静脉压(free portal pressure,FPP)均明显低于治疗前,治疗前后比较差异有统计学意义(P0.05),两组患者治疗后FPP差异无显著性,无统计学意义(P0.05);治疗后及随访期间,分流组分流术组术后食管胃底静脉曲张减轻率和腹水消失率优于断流组,差异有统计学意义(P0.05),近期肝功能好转情况两组间差异无统计学意义(P0.05);术后随访患者,分析两组患者术后再出血、肝性脑病和门静脉血栓的发生率,分流组再出血及门静脉血栓发生率低于断流组,两者差异有统计学意义(P0.05);断流组肝性脑病发生率显著低于分流组,两者差异有统计学意义(P0.01)。结论对于门静脉高压症患者,脾切除及贲门周围血管离断术相比分流术具有更好的治疗效果,该手术方法具有肝性脑病不易发生,较好的维持入肝血流且止血彻底,肝功能影响小的优势,且手术创伤较小、手术死亡率低、操作简便,易于在基层推广。

Comparison between devascularization and shunt in portal hypertension treatment

Objective To investigate the curative effect of the shunt operation versus splenectomy and pericardial devascularization in the treatment of patients with portal hypertension.Methods Retrospective analysis was made of the clinical data of 113 patients who suffered from portal hypertension and accepted the treatment of the shunt operation or splenectomy and pericardial devascularization from June 2005 to June 2012.We compared the symptoms of hypersplenism,liver function,esophageal varices in patients before and after surgery,compared the operative mortality and the incidence of postoperative bleeding,hepatic encephalopathy and portal vein thrombosis.Results According to the clinical data,the FPP after treatment was lower than before.The difference was statistically significant（P 0.05）,and the FPP after treatment in two groups of patients had no statistically significant difference（P 0.05）.During the follow-up period,the occurrence of esophageal and gastric varices as well as the disappearance rate of ascites in the shunt operation group were lower than those of the pericardial devascularization group（P 0.05）.But the liver function between the two groups was not statistically significant（P 0.05）.Moreover,the rate of hepatic encephalopathy in the shunt operation group was pretty much higher than that of the pericardial devascularization group（P 0.01）.However,the incidence of postoperative hemorrhage and portal vein thrombosis between two groups were completely opposite（P 0.05）.Conclusions For patients with portal hypertension,the splenectomy and pericardial devascularization has a better therapeutic effect compared with the shunt operation,which has less prone to hepatic encephalopathy,better maintenance in hepatic blood flow and does a good job in hemostasis which leads to a better liver function.Moreover,it causes less surgical trauma,lower operative mortality.Also,it’s easy to operate and to promote in the whole country.