选择性断流加大网膜包肾术治疗门静脉高压症的随机对照研究

目的 随机对照选择性断流加大网膜包肾术治疗门静脉高压症的临床评估.方法 回顾1998年至2004年间,我院行门静脉高压症手术510例,其中选择性断流术式200例(即高选择离断穿支血管),断流术式160例,缝扎术式140例,脾肾分流术式10例,对照各种术式患者手术前、后门静脉血流量(PVF),自由门静脉压力(FPP).观察近期术后出血、肝性脑病、腹腔感染情况.5年后,随访再出血率、门静脉高压性胃病、肝纤维化指标(PCⅢ)、腹水发生率、食管静脉曲张程度.结果 选择性断流加大网膜包肾术治疗效果较其他术式的PVF、FPP显著降低(P＜0.01),近期出血、肝性脑病发生率下降(P＜0.05),腹腔感染差异无统计学意义.5年后,复发出血、门静脉高压性胃病、门静脉血栓发生率均显著下降(P＜0.01),食管胃底静脉曲张程度、腹水情况,肝纤维化指标(PCⅢ)、生存率差异无统计学意义.结论 选择性断流加大网膜包肾术既可高选择离断穿支血管止血彻底,术后复发出血率低,又可保留机体自发性分流,兼有分流术及断流术的特点,且手术操作简单.术后随访,远期疗效明显改善.

A randomized and controlled study on selected splenectomy with great omentum wrapped kindey to portal hypertension

Objective To investigate the selected splenectomy with great omentum wrapped kindey to portal hypertension by a randomized and controlled study.Methods The clinical data of 510 portal hypertension operations in our hospital from 1998 to 2004,including 200 cases of selected splenectomy,160 cases of traditional splenectomy,140 cases of transfixion operations and 10 cases of spleen-kidney shunting operations were studied.The post-portal vessel blood flow(PVF),free partal pressure(FPP) in the patients before and after operations were measured.The short-term incidence of post-operation bleeding,hepatic coma and abdominal cavity infection was observed.At 5th year of the followed-up,rebleeding,portal hypertension gastropathy,hepatic fibrosis indexes(PCIII),the incidence of ascites,and the degree of esophageal varices were also studied.Results Compared with other operations,the selected splenectomy with great omentum wrapped kidney could decrease PVF and FPP significantly(P<0.01).The short-term incidence of post-operation bleeding and hepatic coma was decreased significantly(P<0.05).At 5th year of the follow-up,the incidence of rebleeding and portal hypertension gastropathy was also decreased significantly(P<0.01),However,the PCIII and survival rate had no significant difference.Conclusion The selected splenectomy with gret omentum wrapped kindey could completely dissect the perforating blood vessels with a lower rebleeding rate after operation.This method could preserve the self-shunting and the operation is simple.The long-term curative effect is improved significantly.