摘要
目的探讨急诊手术在治疗门静脉高压症并上消化道大出血中的效果和意义。方法对我院近5年内151例门静脉高压症并上消化道大出血患者行急诊手术的疗效和并发症发生率进行回顾性研究,其中肝功能ChildA级72例,B级58例,C级21例。结果总体出血有效控制率95.3%,断流术死亡率为7.7%(10/130),死亡的主要原因为腹腔内出血、上消化道出血和肝肾综合征,分流术死亡率为38.1%(8/21),死亡的主要原因为肝肾功能衰竭。术后1年生存率为97.7%,3年生存率为94.2%,5年生存率为86.8%。术后1年再出血率为1.5%(2/133),3年再出血率为5.7%(4/70),5年再出血率为7.9%。结论在当今条件下贲门周围血管离断术仍是挽救门静脉高压症并发不可内科控制的上消化道大出血患者生命的主要急诊手段,肝内型门静脉高压急诊手术最好不选择分流手术。
Objective To study the efficacy of emergency operation for the treatment of portal hypertension with massive esophagogastric variceal bleeding at present condition. Methods From January 2001 to June 2005,151 patients with portal hypertension complicated with massive esopha- gogastric variceal bleeding were treated with emergency operation in 4 hospitals. The severity of the liver disease was graded according to the Child＇s criteria： class A （72 patients）, class B （58）, class C （21）. Results The bleeding control rate was 95.3 % and the overall operative mortality rate in disconnection technique was 7.7 96. The major causes of death were upper gastrointestinal bleeding, intraahdominal hemorrhage, hepatic failure and hepatorenal syndrome. Operative mortality rate in by - pass technique was 38.1% ,and the major causes of death were hepatic failure and hepatorenal syndrome. The mean follow- up time was 3.8 years.The 5- ,3- and one- year survival rate was 86.8% （33/38） ,94.2% （66/70） and 97.7 % （130/133） respectively. The 5 - year recurrent bleeding rate was 6.2 %. The 1 - , 3 - and 5 - year recurrent bleeding rate was 1.5% （2/133） ,5.7 % （4/70） and 7.9% （3/38） ,respectively. Conclusion Emergency pericardial devascularization with splenectomy was the first choice for the treatment of portal hypertension with massive esophagogastric variceal bleeding at present condition, especially for those who could not controlled by expectant treatment.
出处
《临床外科杂志》
2007年第10期680-682,共3页
Journal of Clinical Surgery
基金
河南省医学创新人才资助项目(编号:2004019)
关键词
门静脉高压症
断流术
分流术
hypertension, portal
operation
disconnection
shunt
