联合断流术治疗食管胃底静脉曲张破裂出血

目的：探讨吻合器食管横断联合门奇断流术治疗食管胃底静脉曲张破裂出血的效果。方法：将有食管胃底静脉破裂大出血史的门静脉高压症患者120例，随机分为2组，每组60例。联合断流组实施贲门周围血管离断术加吻合器食管下段横断吻合术，对照组仅实施贲门周围血管离断术。观察对比手术后的近期并发症，以及长期随访结果。结果：（1）联合断流组术后总并发症发生率31.7%，对照组为30.0%（P＞0.05）;（2）术后食管胃底静脉曲张消失率联合断流组优于对照组(P﹤0.01);（3）术后再出血率联合断流组低于对照组(P﹤0.05);(4)两组患者术后肝功能均有不同程度的改善,两组间无统计学差异（P＞0.05）;(5)联合断流组长期（4～7年）生存率（98.3%）高于对照组（90.0% ）(P﹤0.05)。结论：贲门周围血管离断加吻合器食管横断吻合术能更有效地治疗食管胃底静脉曲张，降低再出血率，进一步提高了断流术的疗效。

Combined devascularization operation in treatment of ruptured esophagogastric varices bleeding

Objective To explore the treatment efficacy of combined esophageal transection and anastomosis with stapler and portoazygous devascularization(P-AD)in treatment of ruptured osophagogastric varlces and bleeding.Methods One hundred and tweenty patients with portal hypertension and ruptured esophagogastric varices with massive hemorrhage who treated in our hospital from Mar 1998 to Dec 2001 were divided into two groups randomly.Each group had 60 patients.The patients in the combined devascularization group were operated by P-AD and transabdominal esophageal transection and reanastomosis with stapler;and the patents in the control group were operated by P-AD only.The short-term complications and long-term follow-up results were observed and compared.Results The incidence rate of postoperative complications showed no significant difference between the two groups.(P>0.05);the disappearance rate of varices of fundus of stomach and esophagus in the combined devascularization group was higher than that in control group(P<0.01).The re-bleeding rate in the combined devascularization group was less than that in control group(P<0.05).Liver function of the patients in the two groups improved post-operatively,and no significant difference was found between the two groups(P>0.05).The long-term(fourth to seventh year)survived rate of the combined devascularization group was higher than that of control group(98.3% in the combined devascularization group,90.0% in control group)(P<0.05).Conclusions The combined devascularization operation has more effective in treating esophagogastric varices,and can reduce the rate of rebleeding,improve the treatment effect of P-AD.