联合断流术与贲门周围血管离断术治疗肝硬化门静脉高压症的临床疗效对比分析

发布时间：2018-04-26 06:40

本文选题：联合断流术 + 贲门周围血管离断术　；参考：《大连医科大学》2015年硕士论文

【摘要】：目的:比较联合断流术和贲门周围血管离断术治疗肝硬化门静脉高压症的疗效及术后临床特点,探讨合理术式的选择,总结临床经验。方法:通过回顾性分析大连医科大学附属第一临床医院及第二临床医院普外科1996年1月到2012年1月收治的因肝硬化门静脉高压症行贲门周围血管离断术或联合断流术患者的临床资料160例。根据手术方式不同分为联合断流术组(观察组)80例和贲门周围血管离断术组(对照组)80例。比较两组手术时间、禁食时间、急诊止血率、术后1个月内并发症发生率、术后1个月食管胃底静脉曲张消除率、随访术后2年内上消化道出血率及死亡率指标。所有数据均应用SPSS17.0软件进行处理。其中计量资料以平均数±标准差形式表示,符合正态分布的组间比较采用T检验(t-test)分析;计数资料以例数或百分比描述,组间比较采用X2检验分析。以P0.05为差异具有统计学意义。结果:对观察组和对照组术前观察指标性别、年龄、病因、出血史、手术时机、白细胞计数(WBC)、血小板计数(PLT)、血红蛋白(HGB)、门静脉宽度、Child-Pugh分级、食管胃底静脉曲张程度的两两对应比较,所有术前观察指标比较无明显差异(P0.05)。对两组患者术中及术后观察指标比较,其中两组术后急诊止血率、术后1个月内并发症发生率及术后2年内死亡率的比较无明显差异(P0.05),其余手术时间、术后禁食时间、术后1个月食管胃底静脉曲张消失率、术后2年内上消化道出血率指标的比较在存在差异(P0.05)。观察组手术时间232.08±64.24min,禁食时间5.38±1.36d,术后1个月食管胃底静脉曲张消失率90%,术后2年内上消化道出血率3.4%。对照组手术时间211.38±59.36min,禁食时间4.56±1.33d,术后1个月食管胃底静脉曲张消失率72%,术后2年内上消化道出血率15%。观察组手术时间和术后禁食时间长于对照组,观察组术后1个月食管胃底静脉曲张消失率高于对照组,观察组术后2年内上消化道出血率低于对照组。结论:1.在治疗肝硬化门静脉高压症方面,联合断流术与贲门周围血管离断术均能够达到急诊EGVB时止血和术后消除EGV的目标,治疗效果明确。2.贲门周围血管离断术较联合断流术手术时间短、术后禁食时间短,更适合急诊手术。3.联合断流术较贲门周围血管离断术术后近期EGV消除率高、中期上消化道出血率低,近期及中期疗效更好,比较适合择期手术。
[Abstract]:Objective: to compare the efficacy and clinical characteristics of combined devascularization and pericardial devascularization in the treatment of cirrhotic portal hypertension. Methods: from January 1996 to January 2012, the patients with cirrhotic portal hypertension treated in the first Clinical Hospital and the second Clinical Hospital of Dalian Medical University underwent pericardial devascularization or combined devascularization. Clinical data of 160 patients undergoing flow surgery. According to the different operation methods, the patients were divided into two groups: the observation group (n = 80) and the control group (n = 80). The operative time, fasting time, emergency hemostasis rate, complication rate within 1 month, esophageal and gastric varices elimination rate, upper gastrointestinal bleeding rate and mortality index were compared between the two groups. All data are processed by SPSS17.0 software. The measurement data are expressed in the form of mean 卤standard deviation, T test t-test) is used to analyze the comparison between groups in accordance with normal distribution, and the counting data is described as an example or percentage, and the comparison between groups is analyzed by X2 test. P0.05 as the difference was statistically significant. Results: sex, age, etiology, bleeding history, operation time, white blood cell count, platelet count, hemoglobin HGBG, portal vein width and Child-Pugh grade were observed before operation in the observation group and control group. There was no significant difference in all preoperative indexes of esophageal and gastric varices (P 0.05). There was no significant difference in the rate of emergency hemostasis, the incidence of complications within one month and the death rate within 2 years after operation between the two groups. There was no significant difference between the two groups (P 0.05). The rest of the operative time and the time of fasting after operation were not significantly different between the two groups. The rate of esophageal and gastric varices disappeared 1 month after operation, and the index of bleeding rate of upper digestive tract within 2 years after operation was different (P 0.05). In the observation group, the operative time was 232.08 卤64.24 min, the fasting time was 5.38 卤1.36 days, the esophageal and gastric fundus varices disappeared at 1 month after operation, and the upper gastrointestinal bleeding rate was 3.4% within 2 years after operation. In the control group, the operative time was 211.38 卤59.36 min, the fasting time was 4.56 卤1.33 days, the esophageal and gastric fundus varices disappeared at 1 month after operation, and the bleeding rate of upper digestive tract was 15 times within 2 years after operation. The operative time and fasting time were longer in the observation group than in the control group. The disappearance rate of esophageal and gastric varices in the observation group was higher than that in the control group 1 month after operation. The bleeding rate of upper digestive tract in the observation group was lower than that in the control group within 2 years after operation. Conclusion 1. In the treatment of cirrhotic portal hypertension combined with devascularization and pericardial devascularization can reach the goal of hemostasis in emergency EGVB and the elimination of EGV after operation. Pericardial devascularization is more suitable for emergency operation than combined devascularization. The combined devascularization was more effective than pericardial devascularization in recent EGV elimination rate, lower upper gastrointestinal bleeding rate in the middle stage, better short-term and medium-term curative effect, and more suitable for selective operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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