分流断流联合术治疗食管曲张静脉破裂大出血（附186例报道）

目的　观察分流断流联合术 (脾肾分流加贲门周围血管离断术 )治疗食管曲张静脉破裂大出血的临床效果 ,探讨该术式的合理性。方法　采用分流断流联合术治疗门静脉高压症食管曲张静脉破裂大出血 186例。术中测定自由门静脉压力 ,运用超声彩色多普勒显像观察手术前后门静脉血流动力学变化 ,并对临床效果进行观察、随访。结果　手术死亡率 3 .2 %。术后近期无出血 ,远期再出血率为 8.2 %。术后肝性脑病发生率为 4 .8%。术后 1年、3年、5年、10年生存率分别为 98.1%、89 .9%、84 .3 %、67.9%。术后门静脉压力和门静脉、脾静脉的直径、流量、流速变化与术前相比有非常显著性差异 (P <0 .0 1)。结论　分流断流联合术具有止血效果确切 ,再出血率低 ,肝性脑病发生率低等优点 ,是治疗门静脉高压症食管曲张静脉破裂大出血合理而可行的术式。

Combined Procedure of Spleno-Renal Vein Shunt and Disconnection of Peri-Cardiac Vessel in the Treatment of Esophageal Variceal Bleeding

Objective To observe the clinical effects of the combined procedure of spleno renal shunt and peri cardiac devascularization in the treatment of esophageal variceal bleeding(EVB) and to discuss its rationality.Methods 186 cases of EVB from 1990 to June 2002 were subjected to the combined therapy of spleno renal shunt and peri cardiac devascularization, and the clinical results as well as the changes of hemodynamics of the portal venous system were studied by Doppler color flow imaging (DCFI) and free portal venous pressure (FPP) measured intra operatively.Results The mortality was 3.2% in all patients. No rebleeding occurred during the early postoperative period, and the incidence of rebleeding was 8.2% during a long period of follow up.The rate of hepatic encephalopathy was 4.8% postoperatively, and the long term survival rate of 1 , 3 , 5 , and 10 year was 98.1% , 89.9% , 84.3% and 67.9% respectively. There was a significant decrease both in FPP and in PVF postoperatively ( P < 0.01 ).Conclusion The combined procedure has its own advantage on stopping hemorrhage with lower rate of recurrent bleeding and hepatic encephalopathy. It is an ideal and practical procedure in the treatment of patients with esophageal variceal bleeding.