贲门周围血管离断术治疗肝硬化门脉高压症围手术期处理体会.pdf

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1、194肝胆外科杂志2014年6月第22卷第3期JournalofHepatobiliarySurgery，Vol，22，No．3，Jun．2014贲门周围血管离断术治疗肝硬化门脉高压症围手术期处理体会叶显道【摘要】目的探讨贲门周围血管离断术治疗肝硬化门脉高压症围手术期处理。方法回顾分析2006年1月一2012年12月112例肝硬化门脉高压症病人行贲门周围血管离断术的围手术期处理。结果本组围手术期无死亡病例，无肝性脑病发生。术后腹腔出血7例(占6．3％)，再手术止血5例，2例保守治疗出血停止。门静脉血栓形成3例(占2．7％)，经抗凝溶栓治疗后血栓溶解吸收。结论贲门

2、周围血管离断术治疗肝硬化门脉高压症围手术期处理主要措施是术前肝功能评估、术前术后肝功的改善和维护；纠正和处理凝血功能障碍、重度血小板减少；术后门静脉血栓的有效防治在于方法早期诊断以及抗凝处理；合并胆囊结石肝功能Child—PughA级，可行断流术加胆囊切除。【关键词】门脉高压；贲门周围血管离断术；围手术期【中图分类号】R575【文献标识码】A【文章编号】1006-4761(2014)03-0194-03Theperioperativemanagementofpericardialdevascularizationfortreatmentofthepatientw

3、ithlivercirrhosisandportalhy·pertension(YEXian—daoDepartmentofGeneralSurgyery，TonglingPeople’Hospital，Tongling244000，China)【Abstract】ObjectiveTOexploretheperioperativemanagementofpericardialdevaseularizationfortreatmentofthepatientwithlivercirrhosisandportalhypertension．MethodsRetros

4、pectivelyanalyze112easesoflivercirrhosisandportalhypertensionundergoingpericardialdevaseularizationintheperioperativeperiodfromJanuary2006toDecember2012．ResultsThegroupthroughactivepefiop—erativemanagementcausednodeathandnohepaticeneephalopathy，only7easesofwhichbroughtuppostoperative

5、intra—abdominalhem—orhage，5casesstoppedbleedingthroughreoper~ion，2easesstoppedbleedingthroughconservativetreatment，3casesformedportalveinthrombosis(bloodclotsgraduallydissolvedandabsorptedthroughthrombolytictherapy．Thecasesoflivercirrhosisandportalhypertensionwithgallstonesdidnotappe

6、arseriouscomplicationsafterperieardialdevaseularizationpluscholecystectomy．ConclusionsPreoperativeassessmentandprotectionofliverfunctionwithpostoperativefurtherimprovementandmaintenanceofliverfunctionisthekeymeasuretopromotethepatientrecoverwellandaviodliverfailure．Coagulopathyandthr

7、omboeytopeniaaretheriskfactorsofpostoperativeintra—ab—dominalhemorhageandshouldbecorectedandtreatedinthepreoperativeperiod．Earlydiagnosisandanticoagulationaretheeffectivemethodstopreventpostoperativeportalthrombosis．perieardialdevascularizationpluscholecystectomycanbecarriedouttoward

8、sthepa—tient