吻合器在门奇静脉断流术中应用的效果

目的总结门脉高压症断流术中吻合器行食管下端部分切除再吻合的应用及疗效。方法回顾性分析我院自1996-01～2001-12因门脉高压症行断流术的62例患者的临床资料。其中32例(研究组)行门奇静脉断流合并食管下端吻合器切除吻合,30例(对照组)行单纯门奇静脉断流,观察两组患者的自由门静脉压变化,术后再出血率,手术病死率,食管静脉曲张复发率,吻合口狭窄和吻合口瘘发生率。结果两组门静脉压手术前后均无显著性差异。平均随访25个月,再出血研究组1例,对照组6例(P<0.05)。两组均无手术病死。食管静脉曲张复发,研究组1例,对照组8例(P<0.01)。吻合口狭窄,研究组2例,对照组无(P<0.05)。吻合口瘘研究组1例,对照组无。结论在门奇静脉断流术中,应用吻合器作切除吻合是一种安全、止血更彻底的术式,可明显提高手术疗效。

Application and therapeutic effect of staple in porto-azygos vein devascularization

Objective To investigate the therapeutic effect of staple in porto-azygos vein devascularization on upper GI bleeding due to portal hypertension.Methods From January,1996to December,2001,32protal hypertension patients(the study group)were treated by porto-azygos vein devascularization plus partial resection of lower part of the esophagus with staple(CDH);30portal hypertension patients(the control group)were only treated by porto-azygos vein devascularization.The free portal pressure(FPP),rebleed rate after operation,death rate,the reoccurrence rate of varicose of the esophagus,the stenosis rate of anastomosis and the fistula rate of anastomosis were observed.Results FPP was lower in posr operation than before operation (P<0.05).All the patients were followed up for25months.One patient in the study group and6patients in the control group rebleeded(P<0.05).The reoccurring varicose of the esophagus was1patient in the study group and8patients in the control group(P<0.01).The stenosis rate of anastomosis was2patients only in the study group The fistula rate of anastomosis was1patient only in the study group.Conclusion Staple in porto-azygos vein devascularization is safe and effective.It is a better operation method.