门静脉高压症外科治疗45年回顾

目的 探讨门静脉高压症手术治疗的适应证、手术时机及术式的选择。方法 将４５年来手术治疗的９１２例门静脉高压症患者,按手术时间分为三个时间组,即１９７８年以前,１９７８－１９８９年,１９９０－１９９８年。对每一时间段急诊与择期行分流手术、断流手术及断流术加分流术（联合术）的疗铲进行回顾分析。结果 （１）９１２例２中,Ａ、Ｂ、Ｃ各组,分流术、断流术及联合术例数分别为３４５例、１３例、０例;８４例、２０

Surgical treatment of portal hypertension: 45 year experience

To review the experience in surgery for 912 patients with portal hypertension. Methods The 912 patients were divided into three groups: before 1978 (group A), 1978 1989 (group B),and 1990 1998 (group C). The results were reviewed of portosystemic shunt (PSS), disconnection and disconnection plus PSS for emergency and elective operation at different periods. Results In the 912 patients of groups A, B, C, the number of PSS, disconnection, and PSS plus disconnection was 345, 13, 0; 84, 209, 0; 63, 204, 63, respectively. The number of emergency operation was 45,13 and 4 in each group. The operative mortality of shunt in the groups A, B, C was 7 82%, 7 14% and 0, respectively; that of disconnection in the groups A, B, C 15 38%, 6 28% and 4 94%; and that of PSS plus disconnection in group C 3 51%. Encephalopathy occurred in 14 37% of the PSS group, in 5 68% of the disconnection group, and in 5 77% of the disconnection plus PSS group. Rebleeding occurred in 10 78% of the PSS group, in 18 95% of the disconnection group, and in 7 69% of the disconnection plus PSS group. Conclusions Operative indications for the cirrhotic patients with portal hypertension depend on their liver function. For those patients with poor liver function, surgery is considered when their liver function is improved. We suggest prophylactic operation is valuable. Other indices from barium meal, color ultrasound, and endoscopy are also considered. The number of emergency operation has been decreasing. Since the 1980s, disconnection operation has been adopted increasingly. In our hospital, the number of patients receiving disconnection has been increasing from the early 1980s and the operation has almost replaced shunt operation in the 1990s. Disconnection combined with splenorenal shunt can lower the portal pressure and maintain the portal flow. Disconnection combined with splenorenal shunt seems to be a better procedure of choice.