2200例门静脉高压症患者行脾切除贲门周围血管离断术的近期疗效观察

目的:总结脾切除贲门周围血管离断术治疗门静脉高压症的近期疗效。方法:回顾性分析我院1999年6月-2013年6月收治的2200例择期行脾切除贲门周围血管离断术的肝硬化门静脉高压症患者的临床资料。统计并分析手术前后的止血率、并发症及肝功能指标等。结果:近期随访率78%(1716/2200);其中,上消化道出血史88.3%(1515例),手术止血率为99.1%(1701例),围术期病死率为1.3%(22例),主要死亡原因为感染和肝肾功能衰竭;并发症情况:发热39.8%(683例)、腹腔内出血2%(34例)、门静脉系统血栓51%(875例)、胸腹腔感染3.7%(63例)、肝脓肿0.7%(12例)、胃瘘0.3%(5例)及胰瘘0.3%(5例)。丙肝肝硬化脾切除抗病毒103例,预防手术112例,丙肝切脾抗病毒、预防手术围手术期无死亡;肝功能Child分级:术前85%为A级,术后94%为A级;ALB、TBil、PT及腹水消失率均明显好转。结论:脾切除贲门周围血管离断术对门静脉高压症引起的上消化道出血具有积极的作用,可获得较好的近期疗效,并发症经对症处理可消除或缓解,但如何有效降低术后门静脉系统血栓的形成仍需在今后的临床实践中深入研究。

Short-termEffects of Splenectomy and Esophagogastric Devascularization on the Treatment of Portal Hypertension with 2200 Case*

Objective： To summarize the short-term effects of the splenectomy combined with the esophagogastfic devascularizat- ion on the treatment of portal hypertension. Methods： A retrospective analysis was performed about the clinical data of 2200 patients who were treated by the splenectomy and esophagogastric devascularization in our hospital from June 1999 to June 2013. Then the clinical data, such as the rate of recent bleeding before and after the treatment, the incidence of complications and the liver function of patients, were collected and analyzed. Results： The rate of follow-ups was 78%（1716）; 88.3%（1515） of the patients have the history of upper gastrointestinal bleeding, 99.1%（1701） were taken the surgical hemostasis; The peri-operative mortality was 1.3%（22） of which the main reasons were the infection, the dysfunction of liver and kidney; 39.8%（683） were in fever, 2% （34） represented the intm-abdominal hemorrhage, 51%（875） showed the portal vein thrombosis, 3.7%（63） got the abdominal cavity infection, 0.7% （12） were liver abscess, 0.3%（5） were gastric fistula and 0.3%（5） were pancreatic fistula. There were 103 cases with the hepatitis C cirrhosis undergoing the splenectomy antiviral, 112 cases were taken the preventive surgery with no one death; 85% patients were sorted to A by the Child classification of liver function before the surgery, while the percentage went to 94% when completing the treatment; The indexes of ALB, TBil, PT and the ascites have significantly improved. Conclusion： It is suggested that the short-term effect of the splenectomy combined with the pericardial blood vessel disarticulation on the prevention of upper gastrointestinal bleeding caused by portal hypertension with the advantages of better short-term curative effect and the postoperative complications could be eliminated or reduced by the symptomatical treatment. However, it is more easily lead to the thrombosis of patients with portal hypertension which might be required to explore rnore operative methods.