目的 评估选择性贲门周围血管离断术治疗胃底食管下段静脉曲张伴出血的临床效果。方法 回顾性分析62例采用选择性贲门周围血管离断术治疗门静脉高压症胃食管静脉曲张伴出血的病例。分析指标包括:术后并发症发生、死亡、复发出血、肝性脑病和预后情况。结果 所有出血病例均得到彻底止血,围手术期死亡率为0。术后并发症主要有门静脉血栓(3.6%,2/62),胸腔积液(7.7%,5/62)以及切口皮下脂肪坏死、液化(1.6%,1/62);复发出血者有8.1%(5/62),均经过保守治疗而愈,围手术期无肝性脑病发生。结论 选择性贲门周围血管离断术既做到了彻底断流,同时又保留了自发性门腔分流,相较于传统的贲门周围血管离断术式,在治疗食管下段静脉曲张伴出血方面更加科学和合理。
Objective To evaluate the clinical effect of selective pericardial devascularization on gastroesophageal variceal bleeding.Methods A retrospective analysis was made on 62 cases of gastroesophageal variceal bleeding due to portal hypertension who were treated with selective pericardial devascularization.Outcome indicators included postoperative complication rate, mortality rate, recurrent bleeding, hepatic encephalopathy, and prognosis.Results All cases obtained complete hemostasis with no perioperative death.Postoperative complications included portal vein thrombosis (3.6%, 2/62), pleural effussion (7.7%, 5/62), and subcutaneous fat necrosis and liquefaction (1.6%,1/62); recurrent hemorrhage also happened (8.1%, 5/62).All patients were recovered after conservative treatment, and no hepatic encephalopathy occurred during the perioperative period.Conclusion Selective pericardial devascularization achieves complete devascularization while retaining spontaneous portal shunt, which is more scientific and reasonable in the treatment of gastroesophageal variceal bleeding than traditional pericardial devascularization.
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