中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
2期
116-119
,共4页
张清华%潘万能%徐刚%张雪峰%姚冠羽
張清華%潘萬能%徐剛%張雪峰%姚冠羽
장청화%반만능%서강%장설봉%요관우
门静脉压%胃肠出血%食管和胃静脉曲张%断流术
門靜脈壓%胃腸齣血%食管和胃靜脈麯張%斷流術
문정맥압%위장출혈%식관화위정맥곡장%단류술
Portal pressure%Gastrointestinal hemorrhage%Esophageal and gastric varices%Devascularization
目的 分析选择性断流术后门静脉压力梯度(portal pressure gradient,PPG)的改变与门静脉高压症患者术后并发症及远期疗效的关系,探讨PPG在评价患者再出血中的作用.方法 收集135例行选择性断流术门静脉高压症患者的临床资料,测量切脾前与断流术后PPG的变化,并与其术后并发症及远期疗效作统计学分析.结果 本组135例门静脉高压症患者均接受断流手术治疗,术后死亡2例(1.5%).依据断流术后PPG＜12 mm Hg、PPG 12 mm Hg但与切脾前比较至少下降20%、PPG≥12 mm Hg但与切脾前比较下降＜20%将患者分为3组,分别为62例、41例和32例.3组术后并发症发生率之间相比差异无统计学意义(P＞0.05).3组1、2、3年累计未出血率分别为100%:100%:95%、100%:97%:90%、100%:93%:87%,3组之间相比差异均有统计学意义(x2=6.859,P=0.032).COX风险回归亦显示PPG是影响门静脉高压症患者术后上消化道出血复发的独立因素(P=0.002).3组1、2、3年累计生存率分别为100%:100%:94%、98%:95%:92%、97%:93%:88%,3组之间相比差异均无统计学意义(x2=2.917,P=0.233).结论 选择性断流术后PPG变化是门静脉高压症患者上消化道出血复发的一项预测指标,但不是生存率的一项预后指标.
目的 分析選擇性斷流術後門靜脈壓力梯度(portal pressure gradient,PPG)的改變與門靜脈高壓癥患者術後併髮癥及遠期療效的關繫,探討PPG在評價患者再齣血中的作用.方法 收集135例行選擇性斷流術門靜脈高壓癥患者的臨床資料,測量切脾前與斷流術後PPG的變化,併與其術後併髮癥及遠期療效作統計學分析.結果 本組135例門靜脈高壓癥患者均接受斷流手術治療,術後死亡2例(1.5%).依據斷流術後PPG＜12 mm Hg、PPG 12 mm Hg但與切脾前比較至少下降20%、PPG≥12 mm Hg但與切脾前比較下降＜20%將患者分為3組,分彆為62例、41例和32例.3組術後併髮癥髮生率之間相比差異無統計學意義(P＞0.05).3組1、2、3年纍計未齣血率分彆為100%:100%:95%、100%:97%:90%、100%:93%:87%,3組之間相比差異均有統計學意義(x2=6.859,P=0.032).COX風險迴歸亦顯示PPG是影響門靜脈高壓癥患者術後上消化道齣血複髮的獨立因素(P=0.002).3組1、2、3年纍計生存率分彆為100%:100%:94%、98%:95%:92%、97%:93%:88%,3組之間相比差異均無統計學意義(x2=2.917,P=0.233).結論 選擇性斷流術後PPG變化是門靜脈高壓癥患者上消化道齣血複髮的一項預測指標,但不是生存率的一項預後指標.
목적 분석선택성단류술후문정맥압력제도(portal pressure gradient,PPG)적개변여문정맥고압증환자술후병발증급원기료효적관계,탐토PPG재평개환자재출혈중적작용.방법 수집135례행선택성단류술문정맥고압증환자적림상자료,측량절비전여단류술후PPG적변화,병여기술후병발증급원기료효작통계학분석.결과 본조135례문정맥고압증환자균접수단류수술치료,술후사망2례(1.5%).의거단류술후PPG＜12 mm Hg、PPG 12 mm Hg단여절비전비교지소하강20%、PPG≥12 mm Hg단여절비전비교하강＜20%장환자분위3조,분별위62례、41례화32례.3조술후병발증발생솔지간상비차이무통계학의의(P＞0.05).3조1、2、3년루계미출혈솔분별위100%:100%:95%、100%:97%:90%、100%:93%:87%,3조지간상비차이균유통계학의의(x2=6.859,P=0.032).COX풍험회귀역현시PPG시영향문정맥고압증환자술후상소화도출혈복발적독립인소(P=0.002).3조1、2、3년루계생존솔분별위100%:100%:94%、98%:95%:92%、97%:93%:88%,3조지간상비차이균무통계학의의(x2=2.917,P=0.233).결론 선택성단류술후PPG변화시문정맥고압증환자상소화도출혈복발적일항예측지표,단불시생존솔적일항예후지표.
Objective To investigate the relationship between the changes of portal pressure gradient after selective devascularization with postoperative complications and recurrent bleeding of gastroesophageal varix in patients of portal hypertension. Methods The clinical data of 135 cases of portal hypertension undergoing selective devascularization was collected. Portal pressure gradient was measured before splenectomy and after selective devascularization, and was analyzed against postoperative complications and recurrent bleeding. Results In this study, 135 patients of portal hypertension underwent selective devascularization, two cases died during perioperative period ( 1.5% ). Postoperatively patients were divided into three groups based on PPG ＜ 12 mm Hg after selective devascularization (62 cases), HVPG ≥ 12 mm Hg but a more than 20% of decrease off the pre-splenectomy baseline (41 cases) and HVPG ≥12 mm Hg with less than 20% of decrease from the baseline (32 cases). The postoperative complications between the three groups were of no significant difference ( P ＞ 0. 05 ). The 1,2,3 year cumulative rate of no variceal rebleeding of the three groups were 100% vs. 100% vs. 95%; 100%vs. 97% vs. 90%; and 100% vs. 93% vs. 87% (x2 =6. 859, P = 0. 032). COX regression analysis indicated portal vein pressure gradient was an independent prognostic factor of variceal bleeding recurrence (P=0.002). 1,2,3 year cumulative survival rates of the three groups were 100% vs. 100% vs. 94%; 98% vs. 95% vs. 92%; 97% vs. 93% vs. 88%, there were no significant difference among the three groups ( x2 = 2. 917, P = 0. 233 ). Conclusions The decrease in the PPG after selective devascularization is a predictor for the risk of rebleeding but not for survival after selective devascularization.
