门脉高压症食管胃底静脉曲张破裂出血急诊手术探讨

目的　探讨门静脉高压症食管胃底曲张静脉破裂出血急诊手术治疗。方法　回顾性总结 47例门脉高压症并食管胃底静脉曲张破裂大出血的急诊手术指征、手术方式及术后再出血治疗。结果　急诊手术后 44例达到了满意止血 ,术后 6天再出血死亡 1例 ,术后 15天内再次出血死亡 2例。 5年随访 2 8例 ,生存 15例 ,相继死于门脉高压性胃病再次出血 6例、复发 1例、肝功能衰竭 4例、肝癌 2例。结论　急诊手术是治疗门脉高压症食管胃底静脉曲张破裂出血有效措施 ;手术主张行脾切除加贲门周围血管断流术 ;门脉高压症性胃病是远期再出血的主要原因 ,应给予足够的重视。

Emergency Operative Treatment of Esophageal Gastric- fundus Variceal Bleeding Caused by Portal Hypertension

Objective To investigate the emergency operative treatment of esophageal gastric-fundus variceal bleeding (EGVB) caused by portal hypertension. Methods We analyzed the operation indication, operation method and treatment of re-bleeding after operation of 47 patients with EGVB caused by portal hypertension. Results The effect of surgical hemostasis is satisfactional in 44 patients. 1 patient died 6 days later and 2 patients died 15 days later because of re-bleeding. 28 patients were followed up for 5 years. Among them, 6 patients died of re-bleeding, one patient died of recrudesce of EGVB, 4 patients died of liver function failure, 2 patients died of Hepatocarcinoma. Conclusions The effect of surgical hemostasis is satisfactional in patients with EGVB. The operation method should be splenectomy in combination with pericardial devascularization. Portal hypertension is the major cause of EGVB at a specified future date.