十二指肠去动脉化及吻合器缝合术治疗门静脉血栓形成伴十二指肠静脉曲张严重出血
Duodenal dearterialization and stapling for severe hemorrhage from duodenal varices with portal vein thrombosis.
作者信息
McAlister Vivian C, Al-Saleh Noha A
机构信息
Department of Surgery, 4TU-44, University Hospital, London, Ontario, Canada N6A 5A5.
出版信息
Am J Surg. 2005 Jan;189(1):49-52. doi: 10.1016/j.amjsurg.2004.04.011.
BACKGROUND
Hemorrhage from duodenal varices is a rare but frequently fatal cause of gastrointestinal bleeding. Portal vein thrombosis may worsen the bleeding and prevent access for reduction of variceal pressure.
METHODS
A technique to control bleeding and reduce inflow pressure to the varices is described. It includes ligation of the gastroduodenal and splenic arteries, splenectomy, stapling of the duodenum, and gastroenterostomy.
RESULTS
Three patients, hemodynamically unstable from duodenal hemorrhage, underwent the procedure. No further bleeding was encountered. One patient died of fungal sepsis and liver failure, but 2 are alive without further problems 21 and 24 months later.
CONCLUSIONS
Reduction in arterial inflow, direct variceal ligation, reversal of hypersplenism, and food stream diversion are elements of this procedure that may have contributed the control of severe hemorrhage from duodenal varices associated with portal vein thrombosis.
背景
十二指肠静脉曲张出血是胃肠道出血的一种罕见但常致命的原因。门静脉血栓形成可能会使出血恶化，并阻碍降低曲张静脉压力的途径。
方法
描述了一种控制出血和降低曲张静脉流入压力的技术。它包括胃十二指肠动脉和脾动脉结扎、脾切除术、十二指肠吻合器缝合以及胃肠吻合术。
结果
3例因十二指肠出血导致血流动力学不稳定的患者接受了该手术。未再发生出血。1例患者死于真菌败血症和肝功能衰竭，但2例患者在21个月和24个月后存活且无进一步问题。
结论
减少动脉血流、直接结扎曲张静脉、纠正脾功能亢进以及改道食物流是该手术的组成部分，可能有助于控制与门静脉血栓形成相关的十二指肠静脉曲张严重出血。
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