【摘要】 目的:对比分析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疗效。方法:回顾性分析我院2004-2008年因门静脉高压症实施选择性贲门周围血管离断术患者57例(选择组)和贲门周围血管离断术患者51例(非选择组)的临床资料,通过彩色多普勒超声测定手术前后门静脉与肝动脉血流量变化,并术中监测自由门静脉压力(FPP)。结果:断流术后选择组FPP较非选择组FPP下降幅度更大,差异有统计学意义(P<0.05);断流术后1个月两组患者门静脉血流量均减少,选择组减少更多,差异有统计学意义(P<0.001);断流术后1个月两组肝动脉血流量均增加,选择组增加更多,差异有统计学意义(P<0.001)。选择组近期并发症发生率为15.8%,非选择组为27.5%(P<0.05)。选择组50例完成6～36个月随访,复发出血率为16.0%,3年生存率88%;非选择组42例完成6～36个月随访,复发出血率为30.2%,3年生存率78.6%。结论:选择性贲门周围血管离断术治疗门静脉高压症的临床疗效优于非选择性贲门周围血管离断术。更多还原

【Abstract】 Objective To compare the effects of selective and nonselective paraesophagogastric devascularization on portal hypertension. Methods The clinical data of 57 patients receiving selective paraesophagogastric devascularization (SED group) and 51 patients receiving nonselective paraesophagogastric devascularization (ED group) were retrospectively analyzed. The changes of blood stream volume of portal vein (PV) and hepatic artery were measured by color doppler ultrasonography after the operation , and the free portal pressure (FPP) was measured during the operation. Results FPP in SED group was decreased more significantly than that in ED group after the operation (P < 0.05). The blood stream volume of portal vein was decreased and that of hepatic artery was increased in both groups one month after the operation , and those were more significant in SED group (P < 0.001). Early complication rate in SED group was lower than that in ED group (15.8% vs 27.5%, P < 0.05). Fifty patients in SED group and 42 patients in ED group were followed up for 6 to 36 months, the recurrent hemorrhage rate was 16.0% and 30.2% , and 3-year survival rate was 88% and 78.6% , respectively. Conclusion The effect of selective paraesophagogastric devascularization was superior to that of nonselective paraesophagogastric devascularization on portal hypertension.更多还原