摘要
目的:改良青木春夫断流术用于急诊治疗食管胃底静脉破裂出血的安全性和有效性研究。方法:回顾性分析肝硬化合并胃底食管静脉破裂出血60例患者,24 h保守治疗无效的27例急诊行改良青木春夫断流术(Ⅰ组);另外33例出血经内科治疗控制后,择期行相同手术(Ⅱ组)。术后随访4年,对比观察术后再出血、肝昏迷、肝腹水以及生存状况。Ⅰ、Ⅱ组失访患者分别为3、4例,将Ⅰ组24例、Ⅱ组29例纳入研究。结果:Ⅰ组术后再出血5例、肝性脑病2例、肝腹水3例;围手术期死亡5例,均为Child-Pugh C级患者,其中死于肝性脑病合并肝功能衰竭2例、重度腹水合并感染导致肝功能衰竭2例,术后再出血死亡1例;1、2、4年存活率为79.2%、100%、100%。Ⅱ组术后发生肝性脑病1例、肝腹水4例;无围手术期死亡;4年随访中死亡2例,1例术后2年死于重度腹水伴腹腔感染导致的肝功能衰竭,1例术后4年死于再出血;1、2、4年存活率分别为100%、96.6%、93.1%。Ⅰ、Ⅱ组围手术期死亡率为20.8%(5/24)、0(P<0.01);术后再出血率为20.8%(5/24)、3.4%(1/29,P<0.05),术后肝性脑病发生率为8.3%(2/24)、3.4%(1/29,P<0.05);肝腹水发生率为12.5%(3/24)、13.8%(4/29,P>0.05);2组术后1年存活率差异亦有统计学意义(P<0.01)。结论:改良青木春夫断流术在治疗和预防食管胃底静脉破裂出血方面是安全的、有效的;但对于Child-Pugh分级C级的急诊患者,其围手术期死亡率高,急诊选用应慎重。
Objective： Researching safety and efficacy of Improved Aoki, Haruo surgery for treatment of esophageal and gastric variceal bleeding. Methods： Retrospective analysis of Jan 2004 to Jan 2008 treated 60 cirrhosis patients with esophageal and gastric varices bleeding, Improved Aoki the Haruo surgery were performed in 27 emergency bleeding cases when conservative treatment （usually for 24 hours） failed （groupⅠ）. others 33 cases were controlled by medicine and then done the same procedure （groupⅡ）. Compared post-operative liver function, hepatic coma situation, ascites situation, and observed the re-bleeding, and prognosis after operation in two group. Results： 7 cases C3 cases in groupⅠ , 4 cases in groupⅡ ）were excluded from the data of this study because of losing follow-up. Preoperative Child-Pugh grade： 5-6 points, 9 cases, 14cases. 7-9 points, 9 cases, 12cases. ≥10 points 6 cases, 3cases, respectively, in group Ⅰ and Ⅱ. five cases of postoperative bleeding, two cases of hepatic encephalopathy, three cases with ascites, five cases of perioperative death （the cause of death of hepatic encephalopathy with hepatic failure in 2 cases, severe ascites infection caused liver failure in 2 cases, the fifth patient died of postoperative bleeding ）in groupⅠ 1, 2, 4-year survival rates post-operation were 79.2%, 100%, 100% in group Ⅰ . In group II no perioperative death, 1 case of hepatic encephalopathy, four cases had ascites, one cases died of re-bleeding four years later, one cases died of postoperative 2 years with severe ascites and abdominal infection, both of them died of Liver failure. 1, 2, 4-year survival rates were 100%, 96.5%, 93.1% respectively in group II. Peri-operative mortality rate was 20.8%, 0 （ P 〈 0.01 ）. Rebleeding rate of postoperative was 20.8%, 3.4% （P〈 0.05）. The hepatic encephalopathy was 8.3%, 3.4% （P〈 0.05）. ascites of postoperation was 12.5%, 13.8% （P〉 0.05）respectively In group I and II. Conclusion： Improvement Aoki, Haruo su
出处
《中国现代普通外科进展》
CAS
2013年第1期27-30,共4页
Chinese Journal of Current Advances in General Surgery
基金
南京市医学科技重大项目发展基金
