【摘要】 目的观察Hassab手术联合食管曲张静脉套扎术治疗门静脉高压症食管静脉曲张破裂出血的临床疗效。方法将近5年间收治的9 3例门静脉高压症食管静脉曲张破裂出血的患者随机分成3组,分别实施单纯性内窥镜食管曲张静脉套扎术(endoscopic variceal ligation,EVL)、贲门周围血管离断术(Hassab手术)及EVL联合Hassab手术(联合治疗组),对其临床效果进行比较分析。结果3组急性止血率无差异(P>0.0 5);联合手术组术后近期无出血,远期再出血率为5.7%明显低于EVL组和Hassab手术组(P<0.0 5);术后EVL组、Hassab手术组、联合手术组的奇静脉血流量分别下降2 2.7%,3 0.4%,4 5.7%。结论联合手术组同时阻断了胃食管腔内外的异常门奇静脉分流,食管曲张静脉获得根治,且有脾功能亢进消失、奇静脉血流量降低明显、止血效果确切、再出血率低等优点,是治疗门静脉高压症食管静脉曲张破裂出血的合理而可行的术式。更多还原

【Abstract】 Objective To observe the clinical effects of pericardial devascularization(Hassab operation)(combined) with endoscopic variceal ligation(EVL) in the treatment of esophageal variceal bleeding(EVB) in portal hypertension and to discuss its rationality.Methods The clinical data of 93 patients with EVB(admitted) in the recent 5 years being randomly divided into undergoing one of three surgical procedures(including) EVL,Hassab operation and the combined procedure respectively were analyzed and compared.Results Acute hemostatic rate of the three procedures had no significant difference(P>0.05).In the combined procedure group,no short-term bleeding occurred and the incidence of rebleeding was 5.7% during(long-term) follow-up.The incidence of rebleeding was significantly lower in the combined procedure group than in EVL and Hassab operation group(P<0.05).Blood flow volume of azygos venous system decreased postoperatvely by 22.7%,30.4% and 45.7% in EVL,Hassab operation and the combined procedure respectively.(Conclusions) The combined operation can interrupt abnormal portal-azygous shunts within and outside the gastroesophageal lumen and thus can radically treat esophageal varices and promote the disappearance of(hypersplenism),so can significantly decrease azygous venous blood flow.It has the advantage of achieving(secure) stoppage of bleeding and has a low rate of rebleeding.The combined operation is a rational and feasible operation in the treatment of patients with esophageal variceal bleeding due to portal hypertension.更多还原