摘要
目的 总结采用脾切除贲门周围血管离断术治疗门静脉高压症的经验和分析其疗效。 方法 从 1972年 5月至 1999年 10月 ,共 5 0 8例门静脉高压症患者行该术式治疗 ,其中 389例为肝炎后肝硬化 ,141例为晚期血吸虫病或合并慢性病毒性肝炎。 结果 止血率 96 9% ,总的手术死亡率为 4 5 %。主要死亡原因为上消化道出血 ,腹腔内出血 ,肝衰和肝肾综合症。平均随访时间为 3 8年。 5年存活率为94 1% ,10年为 70 7%。复发出血率 5年为 6 2 % ,10年为13 3%。术后肝性脑病发生率 5年为 2 5 % ,10年为 4 1%。 结论 贲门周围血管离断术是治疗门静脉高压症的首选术式 ,我们的经验是 :(1)应作到完全彻底的门 奇断流术 ;(2 )应根据贲门周围的解剖进行手术 ,并掌握有关的手术技术 ;(3)合理掌握手术适应证和手术时机 ;(4 )
WT5”FZ] To review our experiences in and evaluate the efficacy of pericardial devascularization with splenectomy for the treatment of portal hypertension. [WT5HZ]Methods[WT5”FZ] From May 1972 to October 1999, 508 patients with portal hypertension were treated with this operation. 319 of them had posthepatitic cirrhosis, and 141 late stage schistosomiasis or accompanied chronic virual hepatitis. [WT5HZ]Results[WT5”FZ] The bleeding control rate was 94 1%, and the overall operative mortality rate was 4 5%. The major causes of death were upper gastrointestinal bleeding, intraabdominal hemorrhage, hepatic failure and hepatorenal syndrome. The mean follow up time was 3 8 years.The 5 year survival rate was 94 1%, and the 10 year survival 70 7%. The 5 year recurrent bleeding rate was 6 2%. The 10 year recurrent bleeding rate was 13 3%. The rate of postoperative hepatic encephalopathy was 2 5% at 5 years, and 4 1% at 10 years. [WT5HZ]Conclusions[WT5”FZ] Pericardial devascularization with splenectomy was the first choice for the treatment of portal hypertension, especially for posthepatitic cirrhosis. The following were our experience: (1) thorough porto azygos disconnection; (2) performing the operation in according to pericardial anatomy with correct surgical techniques; (3) selection of operative candidates and opportunity; (4) emphasizing perioperative management and preventing complications. [WT5HZ]
出处
《中华外科杂志》
CAS
CSCD
北大核心
2000年第9期645-648,I037,共5页
Chinese Journal of Surgery
