近段胃壁内外双重断流术治疗门静脉高压症出血的远期疗效

目的分析近段胃壁内外双重断流术式治疗门静脉高压症致上消化道出血的远期疗效。方法 1989—2008年笔者对住院治疗的367例肝硬化门静脉高压症致上消化道出血患者行壁内外双重断流术,择期手术309例,急诊手术58例;随访1~19年,平均随访16年。结果急诊手术止血率100%,术中断流后门静脉压力平均下降4.3 cm H2O,术后6~19年再出血共8例,再出血率2.5%。存活率1~5年,6~10年,11~19年分别为83.05%,91.85%,92.80%。结论近段胃壁内外双重断流术式治疗门静脉高压症致上消化道出血即时止血率高、并发症少、再出血率低、长期生存率高,是治疗门静脉高压症致上消化道出血安全、有效的重要手术方法。

Long-term cutcome of double devascularization on portal hypertension complicated with upper GI bleeding

Objective:To summarize long-term effects of surgical treatment with double devascularization on portal hypertension complicated with  upper gastrointestinal bleeding (UGIB).
Methods:A total of 367 patients with UGIB due to portal hypertension underwent double devascularization from1989 to 2008, and were followed up for 1 to 19 years (average 16 years). Three hundred and nine cases underwent elective surgery and 58 cases underwent emergency surgery.
Results:Bleeding was controlled in all 58(100%) cases after emergency operation. The average portal pressure reduction was 4.3 cm H2O. Follow-up at 6-19 years showed rebleeding in 8 cases(2.5%).The survival rate at 1-5, 6-10 and 11-19 years was 83.05%, 91.85% and 92.80%  respectively.
Conclusions:Double devascularization is a safe and effective treatment for portal hypertension complicated with UGIB becauce it has high, emostasis rate, fewer complications, low rebleeding rate and high long-term survival.