经胸门奇断流术治疗食管静脉曲张破裂出血

食管静脉曲张破裂大出血是门脉高压的致命性并发症,多年来一直采用门脉降压术以防止出血。然而,日本现已很少施行分流而改作断流。 门奇断流分经腹与经胸两大类,后者为Sugiura首创。我院1960年以来采用经腹断流;但自1977年开始改作经胸断流,至1982年止,共行经腹58例;经胸35例。并对Sugiura手术作了一些简化改良,如免除了食管横断、迷走神经前干切断及幽门成形术等,简化后的手术疗效不及sugiura手术,但仍比经腹为佳。 结合解剖研究,认为经腹途径对冠状静脉系统,裂孔以上的食管均难施行彻底的去血管术。

TRANSTHORACIC ROUTE FOR THE INTERRUPTION OF PORTOAZYGOS CIRCULATION IN THE TREATMENT OF ESOPHAGEAL VARICES

Massive bleeding is a lethal complication of portal hypertension. Portal decompression has usually been used to as a preventive measure for many years. However, in Japan, shunt operations are rarely performed now and are gradually replaced by portoazygos vein interruption.Portoazygos vein interruption operation consists of two main types, transabdo-minal and transthoracic, the latter first reported by Sugiura in Japan. In our college the transabdominal route was practiced from 1966, but since 1977 has been replacedby transthoracic route. A total of 58 transabdominal cases and 35 transthoracie cases have now been done altogether. The transthoracic procedure is a modification of the Sugiura operation, omitting esophageal transection, anterior trank vagotomy and pyloroplasty. The results of this modified operation appeared better than the transabdominal procedure.However, topographical anatomical study of the portoazygos system made one believe that it is very difficult to perform a complete interruption of the coronary venous system especially through the transabdominal route.