贲门周围血管离断术治疗门静脉高压症的疗效分析

目的探讨采用贲门周围血管离断术治疗门静脉高压症的疗效。方法自1973年2月-2006年6月我院为178例肝硬化门静脉高压症患者施行了责门周围血管离断术的临床资料进行回顾性分析。结果手术止血率为96．1％，围手术期死亡率为10．7％。主要死亡原因为消化道大出血、术后肝功能衰竭、凝血功能障碍及重度感染全身衰竭等。出院的159例中获得随访140例，随访率为88．1％，随访时间为6个月～27年，平均随访时间5．0年。随访术后累积复发出血率为6．9％（1年），17．7％（3年），30．7％（5年）和36．6％（10年），累积生存率为89．2％（1年），79．6％（3年），68．6％（5年），59．2％（10年）。随访期死亡原因主要为消化道大出血致失血性休克、肝功能衰竭、合并肝癌等。结论贲门周围血管离断术是治疗门静脉高压症的一种有效的治疗手段。做好围手术期处理，正确掌握手术适应症和手术时机，熟练掌握手术技巧和术后跟踪治疗是提高疗效的重要措施。

Analysis of therapeutic efficacies on pericardial devascularization in the treatment of portal hypertension

Objective To summarize the experience and analyze it＇s therapeutic efficacies on pericardial devascularization in the treatment of portal hypertension. Methods From February 1973 to June 2006,the clinical data of 178 cases with cirrhotic portal hypertension received pericardial devascularization were analyzd retrospectively. Results The operative hemostatic rate was in 96.1% and preoperative mortality was 10.7%. The main death causes were postoperative liver function failure, massive digestive tract bleeding,blood coagation disturbance and severe infection associated with general failure. Follow-up was got in 140 cases after discharge from hospital. The follow-up rate was in 88.1%.Follow-up time ranged from 6 months to 27 years （average 5 years）. The postoperative accumulative recurrent bleeding rate of 1,3,5 and 10-year were in 6.9%, 17.7%,30.7% and 36.6% respectively. The accumulative surrival rate of 1,3,5 and 10-yearwere in 89.2%,79.6%,68.6% and 59.2% respectively. The main death causes of follow-up period were caused by massive digestive tract bleeding associated with hemorrhagic shock, liver function failure and associated with liver cancer etc. Conclusion The perieardial devaseulaxization is an effective therapeutic method in the treatment of portal hypertension. But for elevating therapeutic efficacy, a good preoperative management reasonable operation indication, and operative timing, skilled devascularization technic and correct postoperative following treatment are very important.