门静脉高压症并上消化道出血的外科治疗(1)
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【摘要】 目的 探讨门静脉高压症(PHT)并上消化道出血的诊断及手术治疗的效果。方法 对52例肝功能(Child) A~B级PHT并上消化道出血患者手术治疗的临床资料,随机分为治疗组26例以减流、断流、贲门、胃底周围血管离断术式。对照组26例是在治疗组术式的基础上加胃底黏膜下环扎术,并对两组术后远期疗效和再出血率作对比分析。结果 全部病例5年随访,治疗组治愈22例,死亡4例,再出血5例,治愈好转率84.6%。对照组治愈25例,死亡1例,再出血1例,治愈好转率96.1%。两组经统计学处理,对照组治愈率和止血率明显高于治疗组,差异有显著性意义(P<0.05)。结论 减流、断流、贲门周围血管离断术加胃底黏膜下环扎术是门静脉高压症并上消化道出血有效的治疗手段,且较单纯减流、断流、贲门周围血管离断术疗效可靠。
【关键词】门静脉高压症;上消化道出血;外科治疗;胃底黏膜下环扎术
Portal hypertension and surgical treatment of upper gastrointestinal bleeding
XIE Jun-fu.Luyi County,Henan Province Hospital,477282,China
【Abstract】 Objective To study the diagnosis of portal hypertension and upper gastrointestinal bleeding and the effect of the surgical treatment.Methods 52 cases of liver function(Child) A~B Grade PHT and surgical treatment of upper gastrointestinal bleeding in patients with clinical data of 26 cases were randomly divided into treatment group to reduce the flow,drying up,cardia and gastric peripheral vascular surgical amputation.Control group,26 cases in the surgical treatment group,based on increases gastric submucosal cerclage,and the two groups after long-term efficacy and comparative analysis of re-bleeding rates.Results All patients were followed up for 5 years,the treatment group cured 22 cases,4 died,and then bleeding in 5 cases,cure rate of 84.6%improved.Control group,25 cases were cured and 1 died,and then bleeding in 1 case,improved cure rate of 96.1%.The two groups after statistical in control group,bleeding was significantly higher cure rate than that of treatment group,the difference was statistically significant(P<0.05).Conclusions Reduced flow,drying up,breaking away from the cardia peripheral vascular surgery plus fundic mucosa cerclage is a effect treatment to cure portal hypertension and upper gastrointestinal bleeding,And relatively more effective than simple reduced flow,drying up,breaking away from the peripheral vascular surgery cardiac.
【Key words】Portal hypertension;Upper gastrointestinal bleeding; Surgical therapy; Gastric submucosal cerclage
DOI:10.3760/cma.j.issn 1673-8799.2010.06.41
作者单位:477282河南省鹿邑县新集医院
门静脉高压症(portal hypcrtension,PHT)多是由肝硬化导致的一种并发症。食管胃底静脉曲张破裂出血,是肝硬化门静脉高压症患者最常见的并发症及死亡原因[1]。脾切除及贲门周围血管离断术是解决PHT、脾功能亢进、食管胃底静脉曲张破裂出血等问题的外科治疗手段[2] ......
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