门静脉高压症断流术围手术期常见并发症及处置

目的:总结断流术治疗门静脉高压症的经验,分析围手术期并发症发生的原因并探讨处理要点。方法:回顾性分析639例肝硬化门静脉高压症患者的围手术期并发症及处理经验。结果:术前发生的肝功能不良、凝血机制障碍和上消化道出血,对患者手术的安全性有重要影响,需要积极处理。125例发生术后并发症(发生率为19.56%),包括术后腹腔内出血8例(1.25%),近期复发上消化道出血21例(3.29%),感染32例(5.00%),脾静脉血栓39例(6.10%),肝功能不全25例(3.91%)。住院期间死亡7例(病死率为1.1%)。主要死亡原因:复发上消化道出血(4例),肝功能衰竭(3例)。结论:减少围手术期并发症应注意:(1)积极有效的围手术期处理;(2)合理的把握手术时机;(3)术中完全彻底的阻断门奇静脉间的反常血流。

The prevention and treatment of perioperative complications after disconnection of porta-azygous venous shunt in patients with portal hypertension

Objective:To summarize our experience in disconnection of porta-azygous venous shunt for the treatment of portal hypertension, to analyze the cause of perioperative complications and approach how to obviate and treat. Methods:The data of the perioperative complications of 639 patients with hepatic cirrhosis and portal hypertension treated with disconnection from January 1996 to January 2005 in our hospital were studied refrospectively. Results:Hepatic cacergasia, disturbances of blood coagulation and upper gastrointestinal bleeding occurred in preoperative patient, which would cause serious consequences during the operation. So these should be positively treated. Postoperative complications occurred in 125 of all the patients (the incidence rate was 19. 56%). 8 patients had intra-abdominal hemorrhage (1.25%). Upper gastrointestinal bleeding recurred in 11 patients (3.29%). 32 patients experienced postoperative infection (5.00%). 39 patients suffered from thrombosis of splenic vein (6.10%). Hepatic inadequacy exited in 25 patients (3.91%). 7 patients did during hospital stay (the mortality was 1.1%). The main causes of death included recurrent upper gastrointestinal bleeding (4 patients) and liver function failure (3 patients). Conclusions: The precautions to minimize the perioperative complications include:① active perioperative management,②proper selection of operation tine,and ③ complete thoroughgoing disconnection of abnormal porta-azygous venous shunt.