摘要
目的 评价门静脉高压症术后再出血行再次手术的方法及其疗效。方法 对 1993年 1月～ 1999年 12月我科收治的 2 9例门静脉高压症术后再出血接受再次手术治疗的患者进行随访 ,其中肝功能ChildA级 8例、B级 2 0例和C级 1例。结果 本组无手术死亡和近期再出血。术后发生并发症 8例 ,占 2 8%。其中术后胃出血 4例 ,2例需手术止血。随访 2 3例 ,平均随访 35个月。术后行钡餐和胃镜检查 ,再手术后再发静脉曲张的发生率为 2 2 % (5 / 2 3)。其中接受单纯贲门周围血管离断术的 4例 ,有 3例表现为中～重度曲张 ;贲门周围血管离断 +食管横断术 7例中仅有 1例表现为轻度静脉曲张 ;4例肠腔分流术患者中有 1例有中度静脉曲张 ;食管下段 +胃近端切除者 7例均无再发静脉曲张。结论 再次手术采用单纯贲门周围血管离断术者效果较差 ,而接受食管下段 +胃近端切除术的患者均未再发静脉曲张 ,提示该术式具有良好的疗效。
Objective To improve the effect of reoperation for postoperative upper gastrointestinal rebleeding due to portal hypertension.[WT5”HZ] Method [WT5”BZ] The operative procedure and effect of reoperation in 29 patients in our hospital within the last 7 years were evaluated and reviewed. [WT5”HZ] Results [WT5”BZ] There was no mortality and short term rebleeding; 8 patients had postoperative complications(8/29) including postoperative gastric bleeding in 4. 23 patients received barium meal examination and gastroscopy on follow up of an average of 35 months. 5 of 23 patients were found to have newly developed esophageal varices. Among them, 3 patients with moderate severe varices had had simple pericardial devascularization; 1 patient with slight varices had before had pericardial devascularization plus esophagus transection and reanastomosis. Only one out of 4 receiving mesocaval shunt developed moderate varices. None of the 7 patients receiving lower part esophagus resection plus proximal gastrectomy developed recurrent esophageal varices.[WT5”HZ] Conclusion [WT5”BZ] The result of simple pericardial devascularization was unsatisfactory. Lower part esophagus resection plus proximal gastrectomy had good short and long term result for the treatment of upper gastrointestinal rebleeding due to portal hypertension.
出处
《中华普通外科杂志》
CSCD
北大核心
2001年第7期392-394,共3页
Chinese Journal of General Surgery
关键词
门脉高压症
食管
胃静脉曲张
再手术
术式
BZ]Hypertension,portal
Esophageal and gastric varices
Reoperation
