门静脉高压症外科手术治疗的疗效评估
The retrospective analysis of surgical outcome of portal hypertension
周光文 1严东羿 1李风 1严佶祺 1万亮 1李勤裕 1马迪 1杨卫平 1李宏为1
作者信息
- 1. 200025,上海交通大学医学院附属瑞金医院外科,上海消化外科研究所
- 折叠
摘要
目的 分析和评价外科手术治疗门静脉高压症并发食管胃底曲张静脉破裂出血的疗效.方法 对1996年1月至2007年10月收治的149例门静脉高压症患者的临床资料进行回顾性分析,其中男性119例,女性30例,男女比例为3.97:1;年龄19～73岁,平均(48.0±10.6)岁.Child-Pugh分级A级110例,B级39例.根据手术方式不同分为断流组(n=85)和分流组(n=64).结果 115例患者获得随访(随访率78.8%),平均随访时间(46.3±30.4)个月.术后1、3、5和10年生存率分别为95.6%、88.7%、83.4%和65.1%,其中断流组术后1、3、5和10年生存率分别为95.4%、87.7%、80.6%和56.3%,分流组则为95.8%、90.1%、86.8%和72.6%,两组差异无统计学意义(P>0.05).多元回归分析结果显示,Child-Pugh分级是影响术后生存时间的重要因素,Child A级患者与Child B级患者的术后生存时间的差异有统计学意义(P<0.01).随访期间再出血率为20.9%,其中断流组22.7%,分流组18.4%,分流组1、3、5年再出血率明显好于断流组(P<0.05).全组肝性脑病发生率为7.0%,其中断流组6.9%,分流组6.1%,两组差异无统计学意义(P>0.05).脾肾分流手术后门静脉压力、内径、流量均有显著下降(P<0.05),但仍保持向肝性血流.结论 分流术和断流术并不影响患者术后长期生存时间,惟一影响因素是术前肝功能Child-Pugh分级;个体化脾肾分流控制食管胃底静脉曲张破裂出血的疗效明显好于断流手术.
Abstract
Objective To retrospectively analyze the surgical outcome of portal hypertension and explore the risk-factors of long-term survival after operation. Methods The data of 149 patients(male 119, female 30,aged from 19 to 73 years old) with portal hypertension treated surgically from January 1996 to October 2007 was collected. Among these patients, there were 110 patients for Child A and 39 patients for Child B according to Child-Pugh classification. According to different surgical modality, all patients were divided into devascularization group(n=85)and shunting group(n=64). Results The follow-up rate was 78. 8% and the average follow-up time was (46. 3±30.4) months. The overall survival rates of 1-,3-,5-and 10-years were 95.6%,88.7%,83.4% and 65.1% respectively. Meanwhile the survival rates of 1-,3-,5-and 10-years in devascularization group and in shunting group were 95.4%,87.7%,80.6%,56. 3% and 95.8%,90.1%,86. 8%,72. 6% respectively. There was no significant difference in survival rate between these two groups (P > 0.05). Child-Pugh classification has been the most important risk-factor that could influence long-term survival after operation by analysis of COX regression and it showed that the long-term survival time in Child A was longer than in Child B. The rehaemorrhagia rates of 1-, 3-and 5-years in shunting group would be much better than in devascularization group. The rate of postoperative encephalopathy in devascularization group and shunting group was 6.9% and 6. 1% respectively and there was no significant difference (P > 0.05). The portal venous pressure and flow of portal vein decreased significantly after shunting operation (P < 0.05). Conclusions The mainly sole risk-factor of long-term survival for portal hypertension has been the classification of Child-Pugh, not surgical procedure. The individualized proximal splenorenal shunt is much better than devascularization in controlling variceal hemorrhagia.
关键词
高血压,门静脉/外科手术/治疗结果Key words
Hypertension,portal/Surgical procedures,operative/Treatment outcome引用本文复制引用
出版年
2009
NETL
NSTL
维普
万方数据