贲门周围血管离断术治疗门静脉高压症的合理性与局限性

目的 :探讨贲门周围血管离断术防治门静脉高压症上消化道出血的合理性和局限性。方法 :结合文献回顾性分析应用贲门周围血管离断术及其改良术式治疗门静脉高压症上消化道出血 4 0例的临床资料。结果 :改良术式全组无手术死亡 ,术后全部病例达到止血的目的 ,随访期间无肝性脑病发生。行标准的贲门周围血管离断术 30例 ,随访 3个月～ 9a,并发再出血 4例 ,死亡 7例 ,健存 3a以上 18例 ,主要并发症是再出血 4例、术后腹水不易消退 5例 ,失访 4例。行贲门周围血管离断术改良术 10例 ,远近期均无再出血发生 ,随访 1～ 8a至今健存 ,已生存 3a以上 6例、4 a以上 5例、5 a以上 2例。结论 :贲门周围血管离断术是预防和治疗门脉高压症引起的食道胃底静脉曲张破裂出血较合理的术式 ,但客观上仍有一定局限性 ,进一步改进这一术式具有重要的临床意义。

Rationality and Localization of Pericardial Devascularization in Treatment of Portal Hypertension

Objective:To probe into the rationality and localization of pericardial devascularization for preventing and treating portal hypertension with upper digestive tract bleeding.Methods:Based on reviewing documents,a retrospective analysis was made on 40 patients with portal hypertension treated by pericardial devascularization.Results:There was no death,no incidence of hepatic encephalopathy because of surgery.Upper digestive tract bleeding was controlled by improved pericardial devascularization in all patients.Eighteen patients had survived beyond 3 years during the period of 3 months to 9 years follow-up for standard pericardial devascularization,rebleeding occurred in 4 patients,ascite heavier than pre-operation in 5 patients at the stage of postoperation.7 patients died and 4 patients lost to follow-up during the period of follow-up.6 patients had survied beyond 3 to 5 years during the period of 1 to 9 years follow-up for improved pericardial devascularization,no rebleeding occurred in 4 patients at the early and last stage of postoperation.Conclusion:Pericardial devascularization has some localization that must be improved for preventing and treating portal hypertension with upper digestive tract bleeding,although it has certain rationality.