中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (02): 156-157.

• 论著 • 上一篇    下一篇

外科治疗门静脉高压症术后再出血70例分析

冯留顺， 李[Author]) AND 1[Journal]) AND year[Order])" target="_blank">李 伟， 李[Author]) AND 1[Journal]) AND year[Order])" target="_blank">李 捷， 叶学祥   

  1. 郑州大学第一附属医院普通外科，河南郑州 450052
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-03-03 发布日期:2009-03-03

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-03-03 Published:2009-03-03

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摘要：

目的 探讨门静脉高压症术后再出血外科治疗手术方式的选择和疗效。方法 回顾性分析郑州大学第一附属医院普通外科1987年1月至2007年12月收治的70例门静脉高压症术后再出血的临床资料。 结果 急诊手术5例，择期手术65例。行肠系膜上静脉-下腔静脉人工血管架桥术（MCS） 37例，断流术26例，肠系膜下静脉-下腔静脉分流术（IMCS）7例，手术死亡6例。随访52例，随访时间6个月至7年。死亡5例，其中2例死于原发性肝癌，1例死于肝衰竭、肝性脑病，2例死于上消化道再出血。 结论 对门静脉高压症术后再出血病人应首先采用积极的非手术治疗，控制出血后择期手术。积极非手术治疗无效者，应急诊手术治疗。MCS、断流术和IMCS是较理想的术式。

关键词: 门静脉高压, 再出血

Abstract:

Surgical treatment of postoperative rebleeding in patients with portal hypertension: an analysis of 70 cases FENG Liu-shun, LI Wei, LI Jie, et al. Department of General Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Corresponding author：FENG Liu-shun, E-mail: xiaojun05312201@126.com Abstract Objective To evaluate surgical treatment of postoperative rebleeding in patients with portal hypertension (PHT). Methods The clinical data of 70 cases of postoperative rebleeding in patients with PHT from January 1987 to December 2007 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Results There were emergency operation in 5 cases and selective operation in 65 cases. C-type mesocaval shunt was done in 37 cases, inferior mesenteric vein-cava shunt (IMCS) in 7 cases, disconnection in 26 cases. Six cases died during hospitalization. Fifty-two cases were followed-up from 6 months to 7 years. Five cases died ( 2 cases died of primary hepatic carcinoma, 1 case died of liver function failure and heatic encephalopathy, and 2 cases died of upper gastrointestinal bleeding). Conclusion Patients with rebleeding after operation of PHT should be performed non-operative treatment at first, and selective surgery should be done later. If aggressive non-operative treatment is not successful, emergency operation should be performed. MCS, redisconnection and IMCS are relatively ideal methods for the surgical treatment.

Key words: portal hypertension, rebleeding