门奇断流并食管下段横断术治疗门静脉高压临床研究

目的 探讨胃肠吻合器在Hassani术（即联合门奇断流术）的应用效果和手术体会。方法 回顾分析我院1998年5月-2005年10月行贲门周围血管离断术加用吻合器行食管下段部分切除再吻合48例的疗效。主要观察食管静脉的消除、再出血率、手术病死率、吻合狭窄及吻合口瘘的发生率以及影响肝功能的一些指标等。结果住院期间无肝性脑病及并发消化道出血。多次胃镜复查食管中下段及胃底静脉曲张消失或减轻，1例患者食管吻合口处可见致密瘢痕形成和吻合口狭窄，1例因术后多脏器功能衰竭死亡。结论 Hassabi术加胃肠吻合器食管下段切割术的联合应用能有效地防治食管、胃底静脉曲张破裂出血，再吻合可使断流更为彻底，降低再出血率，进一步提高断流术的疗效。远期疗效有待进一步随访。

Experience of Transabdominal Gastroesophageal Stapling in Management of Variceal Bleeding in Portal Hypertension (Report of 48 cases)

Objective To investigate the effect of transabdominal gastmesophageal stapling in management of variceal bleeding in portal hypertension with Hassabi operation and sum up our clinical experience. Methods Retrospective analysis of 48 cases with poltal hypertension operated by transabdominal gastmesophageal stapling between May, 1998 and Oct.200g.The elimination of oesophagus venous, the rebleeding rate, the operation mortality, the stricture and the fistula rate and the index that influences the liver function were maily observed. Results No case suffered rebleeding and hepatal encephalopathy during the hospitaligation of the patients. Esophageal varices disappeared or reduced in all cases. One case resulted from stricture and one case died of multiple organ failure. Conclusions Transabdominal extensive oesophagogastric devascularization combined with gastrooesophageal stapling is an effective and safe procedure for control of acute variceal haemorrhage with satisfactory short- term control, but the long-term effect needs to be long follow- up for the patients.