Objective To evaluate the therapeutic effect of selective paraesophagogastric devascularization without
splenectomy in treatment of portal hypertension with upper gastrointestinal hemorrhage.
Methods The clinical data of 27 patients who received selective paraesophagogastric devascularization without splenectomy from 2008 to 2011 were retrospectively analyzed. The hemogram, hepatic function, perioperative compliations, and free portal pressure (FPP) were observed. The patients were followed-up and the re-bleeding rate and survival rate were observed.
Results The FPP decreased significantly(P<0.05) after operation. The complication rate was 33.3%(9/27) after operation, including2 cases(7.4%) stress ulcer bleeding, 1 case (3.7%) acute bleeding portal hypertensive gastropathy, 1 case (3.7%) deep venous thrombosis, 1 case (3.7%) acute lung injury, 1 case (3.7%) death of hepatic encephalopathy, 3 cases(11.1%) new onset portal vein thrombosis. Twenty-four patients were followed up for an average of 27 months (8-57 months). The overal survival rate was 92.6% (25/27).
Conclusion Selective paraesophagogastric devascularization without splenectomy is an effective method for treatment of portal hypertension with upper gastrointestinal hemorrhage.
Citation:
WANG Dong,LI Guangming,ZHU Jiye,HU Zhiping,LENG Xisheng.. Analysis on Therapeutic Effect of Selective Paraesophagogastric Devascularization Without Splenectomy for Treat-ment of Portal Hypertension with Upper Gastrointestinal Hemorrhage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(1): 29-32. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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王宇. 门静脉高压症的外科治疗[J]. 首都医科大学学报, 2007, 28(1):35-38.
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谢敏, 曹亚娟, 潘一明, 等. 选择性断流术治疗门静脉高压症217例[J]. 世界华人消化杂志, 2008, 16(17):1938-1941.
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Goyal N, Singhal D, Gupta S, et al. Transabdominal gastroesophageal devascularization without transaction for bleeding varices:results and indicators of prognosis[J]. J Gastroenterol Hepatol, 2007, 22(1):47-50.
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4. |
Sharma A, Vijayaraghavan P, Lal R, et al. Salvage surgery in variceal bleeding due to portal hypertension[J]. Indian J Gastroenterol, 2007, 26(1):14-17.
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邓美海, 邓鹏, 林楠, 等. 门静脉高压症断流手术后门静脉血栓形成的调查[J]. 中华普通外科杂志, 2007, 22(8):616-618.
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孙勇伟, 罗蒙, 陈炜, 等. 门静脉高压症外科手术后门静脉系统血栓形成[J]. 外科理论与实践, 2006, 11(3):198-120.
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裘法祖, 杨镇. 外科手术在门静脉高压症治疗中的地位和趋势[J]. 外科理论与实践, 1999, 4(2):65-66.
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戴植本, 杨镇. 贲门周围血管离断术10年回顾[J]. 实用外科杂志, 1990, 10(4):199-200.
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Yoshida H, Mamada Y, Taniai N, et al. New methods for the management of gastric varices[J]. World J Gastroenterol, 2006, 12(37):5926-5931.
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10. |
孙勇伟, 吴志勇. 门静脉高压症外科手术后门静脉系统血栓形成[J]. 腹部外科, 2007, 20(4):203-204.
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11. |
杨冬艳, 王辉, 高东梅, 等. 门奇断流术后门静脉系统血栓的超声诊断[J]. 中华超声影像学杂志, 2005, 14(8):634.
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12. |
冷希圣. 肝移植时代如何看待门静脉高压症的断流手术[J]. 中国现代普通外科进展, 2007, 10(1):1-4.
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13. |
冷希圣. 肝移植时代门静脉高压症治疗策略[J]. 中国实用外科杂志, 2009, 29(5):373-376.
|
14. |
杨镇. 选择性贲门周围血管离断术的发展与手术技巧[J]. 中国实用外科杂志, 2009, 29(5):450-451.
|
15. |
杨镇. 选择性贲门周围血管离断术的解剖基础和操作要点[J]. 外科理论与实践, 2006, 11(3):188-189.
|
16. |
曹亚娟, 谢敏, 包善华, 等. 门静脉高压症消化道出血的临床特点分析[J]. 肝胆外科杂志, 2009, 17(6):36-40.
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17. |
Selzner M, Turtle-Newhall JE, Dahm F, et al. Current indication of a modified sugiura procedure in the management of variceal bleeding[J]. J Am Coll Surg, 2001, 193(2):166-173.
|
18. |
吴性江, 曹建民, 吴学豪, 等. 门静脉高压症患者冠状静脉解剖变异及临床意义[J]. 中华外科杂志, 2000, 38(2):89-91.
|
19. |
Gouge TH, Ranson JH. Esophageal transection and paraesophagogastric devascularization for bleeding esophageal varices[J]. Am J Surg, 1986, 151(1):47-54.
|
20. |
陈雷, 冷希圣, 王福顺, 等. 贲门周围血管离断加经腹食管横断吻合术治疗门静脉高压症的疗效评价[J]. 中华普通外科杂志, 2004, 19(11):649-650.
|
21. |
花荣, 吴志勇, 孙勇伟, 等. 断流术中门静脉压力变化及术后再出血的临床研究[J]. 中华普通外科杂志, 2007, 22(3):194-196.
|
22. |
罗蒙, 吴志勇. 门静脉压力测定在肝硬化门静脉高压症术式选择中的意义[J]. 外科理论与实践, 2009, 14(1):7-9.
|
23. |
戴志杰, 殷保兵, 蔡端. 门静脉系统血流动力学改变与手术方式的选择[J]. 肝胆胰外科杂志, 2005, 17(3):255-257.
|
24. |
Orozco H, Mercado MA, Martinez R, et al. Is splenectomynecessary in devascularization procedures for treatment of bleedingportal hypertension?[J]. Arch Surg, 1998, 133(1):36-38.
|
25. |
Lo GH. Management of acute esophageal variceal hemorrhage[J]. Kaohsiung J Med Sci, 2010, 26(2):55-67.
|
- 1. 王宇. 门静脉高压症的外科治疗[J]. 首都医科大学学报, 2007, 28(1):35-38.
- 2. 谢敏, 曹亚娟, 潘一明, 等. 选择性断流术治疗门静脉高压症217例[J]. 世界华人消化杂志, 2008, 16(17):1938-1941.
- 3. Goyal N, Singhal D, Gupta S, et al. Transabdominal gastroesophageal devascularization without transaction for bleeding varices:results and indicators of prognosis[J]. J Gastroenterol Hepatol, 2007, 22(1):47-50.
- 4. Sharma A, Vijayaraghavan P, Lal R, et al. Salvage surgery in variceal bleeding due to portal hypertension[J]. Indian J Gastroenterol, 2007, 26(1):14-17.
- 5. 邓美海, 邓鹏, 林楠, 等. 门静脉高压症断流手术后门静脉血栓形成的调查[J]. 中华普通外科杂志, 2007, 22(8):616-618.
- 6. 孙勇伟, 罗蒙, 陈炜, 等. 门静脉高压症外科手术后门静脉系统血栓形成[J]. 外科理论与实践, 2006, 11(3):198-120.
- 7. 裘法祖, 杨镇. 外科手术在门静脉高压症治疗中的地位和趋势[J]. 外科理论与实践, 1999, 4(2):65-66.
- 8. 戴植本, 杨镇. 贲门周围血管离断术10年回顾[J]. 实用外科杂志, 1990, 10(4):199-200.
- 9. Yoshida H, Mamada Y, Taniai N, et al. New methods for the management of gastric varices[J]. World J Gastroenterol, 2006, 12(37):5926-5931.
- 10. 孙勇伟, 吴志勇. 门静脉高压症外科手术后门静脉系统血栓形成[J]. 腹部外科, 2007, 20(4):203-204.
- 11. 杨冬艳, 王辉, 高东梅, 等. 门奇断流术后门静脉系统血栓的超声诊断[J]. 中华超声影像学杂志, 2005, 14(8):634.
- 12. 冷希圣. 肝移植时代如何看待门静脉高压症的断流手术[J]. 中国现代普通外科进展, 2007, 10(1):1-4.
- 13. 冷希圣. 肝移植时代门静脉高压症治疗策略[J]. 中国实用外科杂志, 2009, 29(5):373-376.
- 14. 杨镇. 选择性贲门周围血管离断术的发展与手术技巧[J]. 中国实用外科杂志, 2009, 29(5):450-451.
- 15. 杨镇. 选择性贲门周围血管离断术的解剖基础和操作要点[J]. 外科理论与实践, 2006, 11(3):188-189.
- 16. 曹亚娟, 谢敏, 包善华, 等. 门静脉高压症消化道出血的临床特点分析[J]. 肝胆外科杂志, 2009, 17(6):36-40.
- 17. Selzner M, Turtle-Newhall JE, Dahm F, et al. Current indication of a modified sugiura procedure in the management of variceal bleeding[J]. J Am Coll Surg, 2001, 193(2):166-173.
- 18. 吴性江, 曹建民, 吴学豪, 等. 门静脉高压症患者冠状静脉解剖变异及临床意义[J]. 中华外科杂志, 2000, 38(2):89-91.
- 19. Gouge TH, Ranson JH. Esophageal transection and paraesophagogastric devascularization for bleeding esophageal varices[J]. Am J Surg, 1986, 151(1):47-54.
- 20. 陈雷, 冷希圣, 王福顺, 等. 贲门周围血管离断加经腹食管横断吻合术治疗门静脉高压症的疗效评价[J]. 中华普通外科杂志, 2004, 19(11):649-650.
- 21. 花荣, 吴志勇, 孙勇伟, 等. 断流术中门静脉压力变化及术后再出血的临床研究[J]. 中华普通外科杂志, 2007, 22(3):194-196.
- 22. 罗蒙, 吴志勇. 门静脉压力测定在肝硬化门静脉高压症术式选择中的意义[J]. 外科理论与实践, 2009, 14(1):7-9.
- 23. 戴志杰, 殷保兵, 蔡端. 门静脉系统血流动力学改变与手术方式的选择[J]. 肝胆胰外科杂志, 2005, 17(3):255-257.
- 24. Orozco H, Mercado MA, Martinez R, et al. Is splenectomynecessary in devascularization procedures for treatment of bleedingportal hypertension?[J]. Arch Surg, 1998, 133(1):36-38.
- 25. Lo GH. Management of acute esophageal variceal hemorrhage[J]. Kaohsiung J Med Sci, 2010, 26(2):55-67.