【摘要】 目的探讨门脉高压症断流术后上消化道再出血的外科治疗方法及其疗效。方法对(1999~2000)年本科收治的34例门脉高压症断流术后上消化道再出血的病人行外科治疗及疗效分析。其中肝功能ChildA组10级,B级18例,C级6例。治疗前钡餐或胃镜检查确诊。结果有14例行非手术外科治疗,2例经药物治疗止血;4例行胃镜下食道静脉套扎(EVL)止血,效果较好;6例行食管胃底曲张静脉硬化剂注射,2例行三腔二囊管止血,疗效不确切,再出血率62.5%(5/8)。20例行手术治疗,9例行肠腔分流,2例(2/9)术后再次发生上消化道出血;术中食管胃底曲张静脉缝扎1例,食管胃底曲张静脉硬化剂注射2例,术后均再次出现上消化道出血;贲门血管再次离断2例,改良食管下段横断术3例,术后近远期疗效均可;贲门周围血管离断加肠腔分流2例,术后有1例上消化道再出血。结论胃镜下食道静脉套扎术在非手术止血中效果较好,适合于不宜手术的病人。手术治疗常选肠腔分流。对前次断流不彻底需再次断流,再次断流门静脉压仍高,则考虑行断流加分流。更多还原

【Abstract】 Objective: To improve the effect and surgical treatment for upper gastrointestinal rebleeding after pericardial devascularization due to portal hypertension. Methods: The surgical therapeutic effect in 34 patients in our hospital from 1999 to 2000 were evaluated and reviewed. The child-pugh classfication was grade A in 10, B in 18, and C in 6 cases. All patients received barum meal examination and gastroscopy. Results: 14 patients were therapied with non-operation; 2 patients were therapied with medicine; endoscopic variceal ligation (EVL) was perfomed effectively in 4 patients; 6 patients were treated with endoscopic injection and 2 cases treated with balloon tamponade respectively, the rate of re-bleeding is 62.5% (5/8); 9 patients had mesocavel shut, among them, 2 rebleeding (2/9); 1 patient had loop ligation of gastro-esophageal and 2 patients had hardener injection of gastro-esophageal, all of them rebleeding; pericardial devascularization was perfomed in 2 patient and modified suiura′s devascularization in 3 patients, the therapeutic effect was effective; 2 patients had pericardial devascularization combined with mesocaval shut, 1 patient rebleeding. Conclusions: EVL is a safe, effective therapy, especially for those patients who had no condition with surgical operation. Mesocaval shut is one of the first selection surgical operations. Pericardial devascularization or combined with mesocaval shut should be perfomed according to operation exploration.更多还原