离断术治疗门脉高压症食管胃底静脉破裂出血34例分析

1977年—1992年间,应用离断术治疗门脉高压症并食管胃底静脉破裂出血病人34例。病理改变以坏死后性肝硬化为主(29/34例);肝功child分级A级7例,B级19例,C级8例。本组34例术后随访14年,获得随访31例,随访率91.2％。术后肝功改善者16例,再出血4例,累积出血率16.1％,死亡4例。分流术和断流术各有优缺点,从远期生存率看,各型手术间无明显区别。既要保持肝脏门脉血管,又要确切控制破裂静脉出血的手术方式是断流术中的贲门周围血管离断术。它适于基层医院,为急诊大出血首选。须强调的是离断时不要遗漏高位食管支血管。

TREAMENT OF RUPTURE OF GASTROESOPHAGEAL VEIN SINDUCED BY PORTAL VEIN HYPERTENSION WITH AMPUTATION:A REPORT OF 34 CASES

From 1977 to 1992, 34 cases of portal vein hypertension complicated with the rupture of gastroesophageal veins were treated with amputation operation, 29 of 34 cases suffered from poste-crotic cirrhosis of liver. According to the Child's classification, 7 ones was grade A, 19 grade B and 8 grade C. 31 of 34 patients were followed up for 14 years after the operation. After the amputation, the function of livers of 16 patients immproved, 4 ones (16. 1%) rebled and 4 patients died Wheter the shunt or cutting operation had itself advantages and disadvantages, but their long - term survival rates were not significantly different, the amputation of the blood vessels around the cardia can maintain the blood supply through the portal vein of liver and control the bleed through the rupture of gastroesphageal veins, it is suitable to the basic hospitals and it is the first choice of the treatment of acute severe bleed induced by the rupture of gastroesophageal veins.