选择性贲门周围血管离断术治疗门静脉高压症并上消化道出血135例治疗体会

摘要

Objective To evaluate the therapeutic effect of selective paraesophagogastric devascularization in the treatment of portal hypertension with upper gastrointestinal hemorrhage. Method The clinical data of 135 patients with upper gastrointestinal hemorrhage due to portal hypertension undergoing selective paraesophagogastric devascularization from 2012 to 2015 were retrospectively analyzed;ninety-four patients received open selective paraesophagogastric devascularization,whereas the other 41 patients received laparoscopic surgery.The hemorrhage,perioperation complications and long-term recurrent upper gastrointestinal bleeding rate were observed.Result The hemostasis rate was 100%,and the complication rate after operation was 11%(15/135) with 3 cases of wound infection,8 cases of portal vein thrombosis,3 cases of gastroparesis, and 1 case of death caused by liver failure 4 days after operation.one hundred and-one patients were followed up for an average of 16 months(3~36 months)with no recurrence of hematemesis. The overall survival rate was 97%(98/101).Conclusionselective paraesophagogastric devascularization is a safe and effective method in the treatment of portal hypertension with upper gastrointestinal hemorrhage, which is worth generalizing.%目的：探讨选择性贲门周围血管离断术治疗门静脉高压症并发上消化道出血的临床疗效，总结治疗体会。方法2012年1月至2015年1月135例患者因门静脉高压症并发上消化道出血于本科行选择性贲门周围血管离断术，其中开腹手术94例，腹腔镜手术41例，观察其手术止血率、并发症及远期效果。结果手术止血成功率100%，术后总体并发症率11%(15/135)，包括3例手术切口感染，8例门静脉血栓，3例胃瘫，1例患者术后并发肝功能衰竭于术后第4天死亡。101个患者获得随访，随访时间3个月至3年，平均16个月，均未再发消化道出血，总体生存率97%（98/101）。结论选择性贲门周围血管离断术治疗门静脉高压症并上消化道出血是安全、有效的。