摘要
目的探讨不游离食管的胃周围血管离断术在门静脉高压症治疗中的应用价值。方法采用回顾性描述性研究方法。收集2018年7月至2022年12月国内3家医学中心收治的94例(宁夏回族自治区人民医院75例、乌海市人民医院12例、吴忠市人民医院7例)门静脉高压症患者临床资料;男68例,女26例;年龄为46(21~70)岁。94例患者均行不游离食管的胃周围血管离断术。观察指标:(1)术中情况。(2)术后并发症情况。(3)随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果(1)术中情况。94例患者顺利完成手术,其中开腹手术82例,腹腔镜手术12例。无死亡患者。94例患者手术时间为(183±85)min,术中出血量为289(158~560)mL。(2)术后并发症情况。94例患者中,术后早期发生门静脉血栓24例,腹腔感染2例,肝性脑病、肺栓塞、腹腔出血需二次手术、胸腔积液需要引流各1例。上述患者经对症治疗后痊愈。所有患者术后无吞咽疼痛及吞咽困难等食管并发症。(3)随访情况。94例患者均获得随访,随访时间为38(6~60)个月。45例有食管旁静脉患者中,断流远侧的膈下食管旁静脉较术前变细36例,闭塞9例。94例患者术后食管静脉曲张(EV)消失、EV轻中度残留、EV重度残留、EV复发、EV出血的例数分别为7、70、9、4、4例。45例有食管旁静脉患者中,7例术后EV消失,49例无食管旁静脉患者术后无EV消失,两者比较,差异有统计学意义(P<0.05)。94例患者中,术后远期发生门静脉血栓及海绵样变17例,肝癌7例,肝性脑病1例。94例患者中,死亡6例。结论不游离食管的胃周围血管离断术用于门静脉高压症治疗安全、可行。
Objective To investigate the application value of peri-gastric devasculariza-tion without dissociation of esophagus for portal hypertension.Methods The retrospective and descriptive study was conducted.The clinical data of 94 patients with portal hypertension who were admitted to three medical centers,including 75 cases in the People′s Hospital of Ningxia Hui Autonomous Region,12 cases in the People′s Hospital of Wuhai and 7 cases in the People′s Hospital of Wuzhong,from July 2018 to December 2022 were collected.There were 68 males and 26 females,aged 46(range,21-70)years.All 94 patients underwent peri-gastric devascularization without dissociation of esophagus.Observation indicators:(1)intraoperative condition;(2)postoperative complications;(3)follow-up.Measurement data with normal distribution were represented as Mean±SD,and measure-ment data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Results(1)Intraoperative condition.All 94 patients underwent surgery success-fully without operation death,including 82 cases receiving open surgery and 12 cases receiving laparoscopic surgery.The operation time and volume of intraoperative blood loss were(183±85)minutes and 289(range,158-560)mL,respectively,for the 94 patients.(2)Postoperative complications.Of 94 patients,early portal vein thrombosis occurred in 24 cases,intra-abdominal infection occurred in 2 cases,hepatic encephalopathy occurred in 1 case,pulmonary embolism occurred in 1 case,intra-abdominal hemorrhage requiring operation to stop bleeding occurred in 1 case and pleural effusion requiring drainage occurred in 1 case.All patients with postoperative complications were cured after treatment.None of the 94 patient had postoperative esophageal complications such as odynophagia or dysphagia.(3)Follow-up.All 94 patients were followed up for 38(range,6-60)months.Of the 45 patients with paraesophageal vein,ther
作者
田明国
李宝定
刘峰
范雄伟
王立云
卜阳
杨勇
吴光明
Tian Mingguo;Li Baoding;Liu Feng;Fan Xiongwei;Wang Liyun;Bo Yang;Yang Yong;Wu Guangming(Department of Hepatobiliary Surgery,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of General Surgery,People′s Hospital of Wuhai,Wuhai 016099,China;Department of General Surgery,People′s Hospital of Wuzhong,Wuzhong 751100,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第12期1484-1489,共6页
Chinese Journal of Digestive Surgery
基金
宁夏回族自治区重点研发计划项目(2022BEG02038)。
关键词
高血压
门静脉
胃周围血管离断术
食管旁静脉
食管静脉曲张
疗效
Hypertension,portal
Peri-gastric devascularization
Para?esophageal vein
Esophageal varices
Efficacy
