选择性贲门周围血管离断术对治疗门静脉高压症的临床价值评估

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1、选择性贲门周围血管离断术对治疗门静脉高压症的临床价值评估摘要目的探讨选择性断流术与传统断流术在门静脉高压症手术治疗中的疗效。方法分析我院从2007年10月至2009年3月行传统断流术26例患者与行选择性断流术的17例患者的临床资料，对两组间的自由门静脉压变化、术后近期并发症、手术时间、住院天数及费用以及随访情况等进行回顾性对比分析。结果选择性断流术术后近期脾窝积液、发热以及随访期间再出血、门静脉高压性胃病发生率明显减低(A0.05),食管胃底静脉曲张程度明显减轻(/K0.05),肝性脑病发生率未增加(Q0.05)；在手术时间、住院天数及费用上优于传统断流术(/K0

2、.05)。结论选择性断流术保留了机体的自发性分流，兼有断流术和部分分流术的优点，明显改善断流术后再出血和PHG发病率高的问题，降低术后并发症的发生。由于对肝功能要求低、操作相对简单、患者术后恢复快，选择性断流术应该成为肝硬化门静脉高压症特别是食管胃底静脉曲张破裂出血的一种较理想的手术方式。【关键词】选择性断流，门静脉高压症，自由门静脉压，手术方式THETHERAPEUTICEFFECTOFSELECTIVEPERICARDIALDEVASCULARIZATIONONPORTALHYPERTENSIONABSTRACTObjectivesToevaluatecomp

3、arativelythetherapeuticeffectsofselectiveandnon-selectivedevascularizationproceduresinthesurgicaltreatmentofportalhypertension.MethodsAtotalof43patientswithportalhypertensionadmittedtoourhospitalOct・2007toMar・2009weredividedintotwogroupsnonrandomly,17caseshadselectivedcvascularization

4、(observedgroup)and26caseshadpericardialdevascularization(conlrolgroup).Theclinicaldataconcerningpreoperativeandpostoperativedifferencesinfreeportalpressure,postoperativeearlycomplications,lengthofoperationstime,lengthofstayinhospital,hospitalspendingandtheFollow-upresultswereretrospe

5、ctivelyanalyzed.ResultsNosignificantdifferenceoffreeportalpressure(FPP)wasshownbetweenthetwogroupsbeforeandafterspleenctory.TheFPPwas23.58+1.55mmHginthecontrolgroup,21・65±2.18mmHgintheobservedgroupaftertheoperation.Comparedwiththecontrolgroup,thepatientsundergoingselectivedevasculariz

6、ationshowedthatfluidinsplenicfossa,febrile,rebleedingandportalhypertensivegastropathyweredecreased(/<0.05)andthedegreeofgastroesophagealvaricealimproveed(7K0.05),whiletheriskofhepaticencephalopathyshowednoincrease(A>0.05).TheFol1ow-upresultsofoperationstime,lengthofstayinhospital,

7、hospitalspendingintheobservedgroupwasbatterthanthatinthecontrolgroup.ConclusionsSelectivedevascularizationhasadvantagesofshuntanddisconnect!on,canpreservespontaneousshuntsofthebodyandhcncceffectivelyattcnuatcearlytermcomplicationsofportalhypertensionandbecauseofthelowrequestofliverfun

8、ction