改良贲门周围血管离断术联合脾脏-肾静脉分流术治疗食管胃静脉曲张出血的效果：与单纯贲门周围血管离断术治疗肝硬化门静脉高压症的对比研究。

Effects of modified splenocaval shunt plus devascularization on esophagogastric variceal bleeding: a comparative study of this treatment and devascularization only in cirrhotic portal hypertension.

机构信息

Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Medical College of Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, No. 256, Youyi West Road, Xi'an, 710068, China.

出版信息

J Hepatobiliary Pancreat Sci. 2010 Sep;17(5):657-65. doi: 10.1007/s00534-010-0262-8. Epub 2010 Mar 2.

DOI:10.1007/s00534-010-0262-8

PMID:20703844

Abstract

BACKGROUND

Pericardial devascularization (PCDV) and portosystemic shunt were reported to have favorable results for the management of portal hypertension in cirrhotic patients in China and the West, respectively. This study was undertaken to investigate the effects of a modified proximal splenocaval shunt plus PCDV on variceal bleeding in patients with portal hypertension.

METHODS

From January 1997 to December 2007, 168 patients with portal hypertension of cirrhotic origin received an operation for gastroesophageal variceal bleeding. Of these, 90 patients received a splenocaval shunt plus a PCDV procedure (Combined Group) and the other 78 patients received a PCDV procedure only (PCDV Group). The procedure-related morbidity and mortality, rebleeding, encephalopathy, and survival rates were analyzed.

RESULTS

Postoperative mortality was 3.3% in the combined group and 5.1% in the PCDV group (P > 0.05). Overall morbidity was 13.3% in the combined group and 15.4% in the PCDV group (P > 0.05). The rate for rebleeding, including variceal bleeding and gastropathy, was 5.1% in the combined group, which was significantly lower than that in the PCDV group, at 16.7% (P < 0.05). The incidence of encephalopathy was 6.63% in the combined group and 6.67% in the PCDV group (P > 0.05). The 1-, 3-, 5- and 10-year survival rates were 97.4, 91.7, 80.0, and 60.0% in the combined group and 96.7, 83.3, 73.3, and 53.3% in the PCDV group (P > 0.05).

CONCLUSIONS

The modified splenocaval shunt plus PCDV is a safe and effective procedure for the long-term control of variceal bleeding; the procedure may not only maintain the portal flow to the liver, but may also protect the liver function in cirrhotic patients. The better clinical outcome means that the procedure may be one of the best choices for treating portal hypertension of cirrhotic origin.

摘要

背景

心包切开去血管术（PCDV）和门体分流术分别在中西方被报道对肝硬化患者门静脉高压的治疗有良好的效果。本研究旨在探讨改良的贲门周围血管离断术加 PCDV 对门静脉高压症患者静脉曲张出血的影响。

方法

1997 年 1 月至 2007 年 12 月，168 例肝硬化门静脉高压患者因胃食管静脉曲张出血接受手术治疗。其中 90 例行脾腔分流加 PCDV 术（联合组），78 例行单纯 PCDV 术（PCDV 组）。分析手术相关并发症和死亡率、再出血、肝性脑病和生存率。

结果

联合组术后死亡率为 3.3%，PCDV 组为 5.1%（P>0.05）。联合组总并发症发生率为 13.3%，PCDV 组为 15.4%（P>0.05）。再出血率（包括静脉曲张出血和胃病）联合组为 5.1%，显著低于 PCDV 组的 16.7%（P<0.05）。联合组肝性脑病发生率为 6.63%，PCDV 组为 6.67%（P>0.05）。联合组 1、3、5、10 年生存率分别为 97.4%、91.7%、80.0%和 60.0%，PCDV 组分别为 96.7%、83.3%、73.3%和 53.3%（P>0.05）。