选择性贲门周围血管离断术治疗门静脉高压
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摘要
目的评估选择性贲门周围血管离断术治疗胃底食管下段静脉曲张伴出血的临床效果。方法回顾性分析62例采用选择性贲门周围血管离断术治疗门静脉高压症胃食管静脉曲张伴出血的病例。分析指标包括:术后并发症发生、死亡、复发出血、肝性脑病和预后情况。结果所有出血病例均得到彻底止血,围手术期死亡率为0。术后并发症主要有门静脉血栓(3.6%,2/62),胸腔积液(7.7%,5/62)以及切口皮下脂肪坏死、液化(1.6%,1/62);复发出血者有8.1%(5/62),均经过保守治疗而愈,围手术期无肝性脑病发生。结论选择性贲门周围血管离断术既做到了彻底断流,同时又保留了自发性门腔分流,相较于传统的贲门周围血管离断术式,在治疗食管下段静脉曲张伴出血方面更加科学和合理。
Objective To evaluate the clinical effect of selective pericardial devascularization on gastroesophageal variceal bleeding.Methods A retrospective analysis was made on 62 cases of gastroesophageal variceal bleeding due to portal hypertension who were treated with selective pericardial devascularization.Outcome indicators included postoperative complication rate, mortality rate, recurrent bleeding, hepatic encephalopathy, and prognosis.Results All cases obtained complete hemostasis with no perioperative death.Postoperative complications included portal vein thrombosis(3.6%, 2/62), pleural effussion(7.7%, 5/62), and subcutaneous fat necrosis and liquefaction(1.6%,1/62); recurrent hemorrhage also happened(8.1%, 5/62).All patients were recovered after conservative treatment, and no hepatic encephalopathy occurred during the perioperative period.Conclusion Selective pericardial devascularization achieves complete devascularization while retaining spontaneous portal shunt, which is more scientific and reasonable in the treatment of gastroesophageal variceal bleeding than traditional pericardial devascularization.
Objective To evaluate the clinical effect of selective pericardial devascularization on gastroesophageal variceal bleeding.Methods A retrospective analysis was made on 62 cases of gastroesophageal variceal bleeding due to portal hypertension who were treated with selective pericardial devascularization.Outcome indicators included postoperative complication rate, mortality rate, recurrent bleeding, hepatic encephalopathy, and prognosis.Results All cases obtained complete hemostasis with no perioperative death.Postoperative complications included portal vein thrombosis(3.6%, 2/62), pleural effussion(7.7%, 5/62), and subcutaneous fat necrosis and liquefaction(1.6%,1/62); recurrent hemorrhage also happened(8.1%, 5/62).All patients were recovered after conservative treatment, and no hepatic encephalopathy occurred during the perioperative period.Conclusion Selective pericardial devascularization achieves complete devascularization while retaining spontaneous portal shunt, which is more scientific and reasonable in the treatment of gastroesophageal variceal bleeding than traditional pericardial devascularization.
引文
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[8] Irisawa A,Shibukawa G,Obara K,et al.Collateral vessels around the esophageal wall in patients with portal hypertension:comparison of EUS imaging and microscopic findings at autopsy[J].Gastrointest Endosc,2002,56(2):249-253.
[9] 杨镇.选择性贲门周围血管离断术的应用解剖[J].中国实用外科杂志,2005,25(11):702-704.
[10] 杨镇,万赤丹,邓小荣.腹腔镜门静脉高压症外科治疗发展与新断流术[J].中华普外科手术学志,2017,11(3):181-184.
[2] 赵辉,李宝金,龙宏刚,等.选择性与非选择性贲门周围血管离断术治疗门静脉高压症的临床研究[J].实用医学杂志,2011,27(15):2739-2741.
[3] Biecker E.Portal hypertension and gastrointestinal bleeding:Diagnosis,prevention and management[J].World J Gastroenterol,2013,19(31):5035-5050.
[4] Lu CL,Cao YJ,Cheng H,et al.Clinical factors that influence the outcome of selective devascularization in the treatment of portal hypertension[J].Oncotarget,2016,7(31):50635-50642.
[5] Yin LN,Liu HP,Zhang YC,et al.The surgical treatment for portal hypertension:a systematic review and meta-analysis[J].ISRN Gastroenterology,2013,2013:4640-4653.
[6] Zhao YJ,Wang CF.The therapeutic effect of splenectomy plus selective pericardial devascularization versus conventional pericardial devascularization on portal hypertension in China:a meta-analysis[J].Oncotarget,2018,9(20):15398-15408.
[7] Bao HL,He QK,Dai NG,et al.Retrospective study to compare selective decongestive devascularization and gastrosplenic shunt versus splenectomy with pericardial devascularization for the treatment of patients with esophagogastric varices due to cirrhotic portal hypertension[J].Med Sci Monit,2017,23:2788-2795.
[8] Irisawa A,Shibukawa G,Obara K,et al.Collateral vessels around the esophageal wall in patients with portal hypertension:comparison of EUS imaging and microscopic findings at autopsy[J].Gastrointest Endosc,2002,56(2):249-253.
[9] 杨镇.选择性贲门周围血管离断术的应用解剖[J].中国实用外科杂志,2005,25(11):702-704.
[10] 杨镇,万赤丹,邓小荣.腹腔镜门静脉高压症外科治疗发展与新断流术[J].中华普外科手术学志,2017,11(3):181-184.