CAJ | 학술논문

目的探讨断流与肠腔分流联合手术的血流动力学变化及其临床效果。方法对1980～1995年采用联合手术治疗的100例门静脉高压症进行回顾性分析。结果分流术后自由门静脉压力(FPP)下降1.92kPa，能够降低门静脉压力，防止出血；联合手术后FPP平均为(2.46±0.30)kPa，仍可保持高水平的向肝血流灌注，减少脑病发生。全组效果满意，无手术死亡。89例随访5～15年无复发出血，脑病5％，总病死率15％。其中肝功能Child C级13例死于肝终末期病变，如肝衰、肝癌及肝肾综合征，5年生存率94.5％，10年生存率68.5％。结论联合手术具有断流术和外周型合理口径分流的特色，是断流和分流术两者优缺点互补，是目前我国治疗门静脉高压症的理想术式。
목적탐토단류여장강분류연합수술적혈류동역학변화급기림상효과。방법대1980～1995년채용연합수술치료적100례문정맥고압증진행회고성분석。결과분류술후자유문정맥압력(FPP)하강1.92kPa，능구강저문정맥압력，방지출혈；연합수술후FPP평균위(2.46±0.30)kPa，잉가보지고수평적향간혈류관주，감소뇌병발생。전조효과만의，무수술사망。89례수방5～15년무복발출혈，뇌병5％，총병사솔15％。기중간공능Child C급13례사우간종말기병변，여간쇠、간암급간신종합정，5년생존솔94.5％，10년생존솔68.5％。결론연합수술구유단류술화외주형합리구경분류적특색，시단류화분류술량자우결점호보，시목전아국치료문정맥고압증적이상술식。
Objective To study the hemodynamic changes in combined portoazygous devascularization and mesocaval shunt for treating portal hypertension and the effect of this operation. Methods 100 cases of portal hypertension who received this combined operation from 1980 to 1995 were analyzed retrospectively. Results Free portal pressure(FPP)after shunt decreased to 1.92 kPa,which decreased portal pressure and preserved with (2.46 ± 0.30)kPa to maintain a good inflow to the liver and the encephalopathy rate was lowered. There was no death, and the effect was satisfactory. 5～15 years follow-up of 89 cases showed no rebleeding,with only 5% of encephalopathy and 15% of total mortality. Among them, 13 cases of Child C died of late-stage hepatopathy, such as liver failure, liver cancer and hepatorenal syndrome,with 94.5% of 5-year survival rate and 68.5% of 10-year survival rate. Conclusion This combined operation is characterized by complete devascularization of sustaining varices and distal partial shunt with logical diameter. A perfect combination of both shunt and devascularization, it's one of the best choices currently available for treating portal hypertension in China.