摘要
目的 总结 1991.8- 1999.8共 8年来我院 18例行急诊手术治疗的食管及胃底曲张静脉破裂大出血病例 ,以探讨适宜的手术适应症及手术方法。方法 将 18例病人归纳为急诊分流术治疗组 (11)例及急诊断流术治疗组 (7例 )。对比两组病人的术前肝功能分级 ,手术前后门静脉压变化情况 ,手术死亡率 ,术后并发症发生率及手术止血率。结果 分流组术前肝功能分级为 Child C级者占 6 3.6 % (7例 ) ,断流术组为 43.9% (3例 )。术后门静脉压于分流术组及断流术组分别平均降低 9.8和 1.9cm H2 O。分流术组术后有 3例发生肝性脑病 ,1例再出血 ,4例于住院期间死亡 ,手术死亡率为 36 .4% ;断流术组有 2例发生再出血 ,无手术死亡。结论 肝硬化门静脉高压症上消化道大出血者 ,经积极内科保守治疗无效者 ,应不失时机坚决施行手术治疗。延误时机只会使全身状况进一步恶化 ,手术死亡率上升。分流术后再出血率低 ,止血确切 ,但术后脑病发生率及手术死亡率均高于断流术 ;断流术后再出血率高于分流术 ,但术后脑病发生率及手术死亡率低 ,特别适用于术前肝功能差的病人。
Objective To evaluate the value of emergent surgical therapy for acute continuous gastroesophageal vaciceal bleeding in cirrhotic patients.Methods 18 cases were divided into two groups,treated with portosystemic shunt(PSS) in group A(11cases),and gastroesophageal devascularization( GED) in group B (7cases).Hepatic function tests,changes in portal pressure pre-and post-operation,mortality and morbidity,bleeding recurrence were compared between the two groups.Results 7cases (63.6%) in group A were of Child C,and 3(43.9%) in group B were of Child C.Bleeding stopped in all patients postoperatively in 2 groups.In group A there was recurrent bleeding in 1 case and postoperative encephalopathy in 3 cases.In-hospiotal mortality was 36.4%(4cases).In group B there was no mortality ,and recurrent bleeding developed in 2 cases which was successfully controlled by conservative therapy.Conclusion Despite a variety of modern conservative therapies including emergent endoscopic ligation and sclerotherapy ,many cirrhotic patients still die of intractable persistent variceal bleeding.Our experience shows that emergent surgical therapy when used properly and in time could remain a therapy of choice.GED which renders less severe burden to the already deteriorated liver function in cirrhotic patients often gives a satisfactory result in terms of hematostasis and acceptable mortality and morbidity when compared with PSS.
出处
《肝胆外科杂志》
2000年第1期23-25,共3页
Journal of Hepatobiliary Surgery
关键词
上消化道出血
急诊
治疗
外科手术
Massive variceal bleeding Emergency Surgery Operation
