摘要
目的 :探讨脾切除联合术中食管曲张静脉套扎治疗门静脉高压症的可行性及疗效。方法 :前瞻性研究 2 5例 (研究组 )乙肝肝硬化门静脉高压症患者脾切除联合术中食管曲张静脉套扎术的疗效 ,并与 2 6例 (对照组 )同期行贲门周围血管离断术的患者进行对比。观察两组食管曲张静脉消除率、门静脉血栓形成率及胃黏膜病变的变化。结果 :平均随诊 12个月 ,研究组食管静脉曲张清除率 96 % (2 4 / 2 5 ) ,对照组 5 0 % (13/ 2 6 ) (P <0 .0 1)。研究组无复发出血 ,对照组复发出血率为 11.5 % (3/ 2 6 ) (P <0 .0 5 ) ,研究组手术前后门静脉高压性胃病分度没有明显差异 (P >0 .0 5 ) ,对照组 8例患者门静脉高压性胃病加重 ,其中一人出现胃黏膜病变出血 (P <0 .0 5 )。研究组术后门静脉血栓发生率 (8% ,2 / 2 5 )明显低于对照组 (34.6 % ,9/ 2 6 ) (P <0 .0 5 )。结论 :脾切除联合术中食管曲张静脉套扎术创伤小 ,并发症少 ,食管曲张静脉消除率高 ,可避免术后胃黏膜病变加重 ,且食管曲张静脉套扎可重复实施 。
Objective To investigate the therapeutic effect of endoscopic variceal ligation (EVL) combined with splenectomy on patients with portal hypertension.Methods The eliminating rate of varicose veins and recurrent bleeding rate were evaluated. Fifty-one paitents with cirrhosis of liver and portal hypertension were randomly divided into 2 groups.We treated 25 portal hypertensive patients using splenectomoy plus EVL. The therapeutic effect of pericardial devascularization in 26 patients with upper gastrointestinal bleeding due to portal hypertension served as the control.Results All patients were followed up for 12 months. There was no death due to the operation. All patients in the study group had no upper gastrointestinal rebleeding during the 12-month follow-up. The rebleeding rate in the control group was 11.5% (3/26). The varicose venis eliminating rate was 96% (24/25) in the study group and 50% (13/26) in the control group (P<0.01). It showed no effect on portal hypertensive gastropathy in the study group, and pericardial devascularization procedure exacerbated the portal hypertensive gastropathy. The thrombosis rate in the portal vein after the operation was 8% (2/25) in the study group and 34.6% (9/26) in the control group (P<0.05).Conclusion EVL combined with splenectomy has less trauma,fewer postoperative complications and high eradication of esophageal varices. It can be used safely in treating portal hypertension.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2004年第1期87-89,96,共4页
Journal of Central South University ：Medical Science
