He B W
Luwan District Central Hospital, Shanghai.
Zhonghua Wai Ke Za Zhi. 1990 Apr;28(4):198-200, 251.
123 cases of recurrent hemorrhage were studied. It was found that the rebleeding rate differed with different original operations. Those with unsatisfactory portal decompression or persistence of varices were prone to rebleeding. Rebleeding within one year occurred in 47.96%, and in late stage in 52.04%. Early postoperative rebleeding should be treated conservatively with intensive circulatory resuscitation. Repeated rebleeding occurred in 89% of the patients, reoperation should be carried out with definite indications. Emergency surgery was usually not recommended. On the operation, portal vein thrombosis was found in 58.8% of the patients, and dilatation of the superior mesenteric vein in 82.9%. Of the fifty six rebleeding cases treated surgically, 21.4% died of further bleeding in 5 years compared with 50.7% treated conservatively. Rebleeding occurred in 62.5% of disconnection cases and in 31.2% of shunt cases. The authors performed mesocaval side-to-side anastomosis in those with enlarged superior mesenteric vein, and restricted portocaval shunt in those without portal thrombosis. Rebleeding patients with regional portal hypertension were better treated with devascularization.
对123例复发性出血患者进行了研究。发现再出血率因不同的初次手术而异。门静脉减压效果不佳或静脉曲张持续存在的患者容易再次出血。一年内再出血发生率为47.96%，晚期为52.04%。术后早期再出血应采用强化循环复苏进行保守治疗。89%的患者发生反复再出血，有明确指征时应进行再次手术。通常不建议进行急诊手术。手术中，58.8%的患者发现门静脉血栓形成，82.9%的患者发现肠系膜上静脉扩张。在接受手术治疗的56例再出血病例中，21.4%的患者在5年内死于再次出血，而保守治疗的这一比例为50.7%。断流术病例的再出血发生率为62.5%，分流术病例为31.2%。作者对肠系膜上静脉扩张的患者进行了肠系膜上静脉-腔静脉侧侧吻合术，对无门静脉血栓形成的患者进行了限制性门腔分流术。区域性门静脉高压的再出血患者采用去血管化治疗效果较好。
