CAJ | 학술논문

目的分析和评价外科手术治疗门静脉高压症并发食管胃底曲张静脉破裂出血的疗效.方法对1996年1月至2007年10月收治的149例门静脉高压症患者的临床资料进行回顾性分析,其中男性119例,女性30例,男女比例为3.97:1;年龄19～73岁,平均(48.0±10.6)岁.Child-Pugh分级A级110例,B级39例.根据手术方式不同分为断流组(n=85)和分流组(n=64).结果 115例患者获得随访(随访率78.8%),平均随访时间(46.3±30.4)个月.术后1、3、5和10年生存率分别为95.6%、88.7%、83.4%和65.1%,其中断流组术后1、3、5和10年生存率分别为95.4%、87.7%、80.6%和56.3%,分流组则为95.8%、90.1%、86.8%和72.6%,两组差异无统计学意义(P>0.05).多元回归分析结果显示,Child-Pugh分级是影响术后生存时间的重要因素,Child A级患者与Child B级患者的术后生存时间的差异有统计学意义(P<0.01).随访期间再出血率为20.9%,其中断流组22.7%,分流组18.4%,分流组1、3、5年再出血率明显好于断流组(P<0.05).全组肝性脑病发生率为7.0%,其中断流组6.9%,分流组6.1%,两组差异无统计学意义(P>0.05).脾肾分流手术后门静脉压力、内径、流量均有显著下降(P<0.05),但仍保持向肝性血流.结论分流术和断流术并不影响患者术后长期生存时间,惟一影响因素是术前肝功能Child-Pugh分级;个体化脾肾分流控制食管胃底静脉曲张破裂出血的疗效明显好于断流手术.
목적 분석화평개외과수술치료문정맥고압증병발식관위저곡장정맥파렬출혈적료효.방법 대1996년1월지2007년10월수치적149례문정맥고압증환자적림상자료진행회고성분석,기중남성119례,녀성30례,남녀비례위3.97:1;년령19～73세,평균(48.0±10.6)세.Child-Pugh분급A급110례,B급39례.근거수술방식불동분위단류조(n=85)화분류조(n=64).결과 115례환자획득수방(수방솔78.8%),평균수방시간(46.3±30.4)개월.술후1、3、5화10년생존솔분별위95.6%、88.7%、83.4%화65.1%,기중단류조술후1、3、5화10년생존솔분별위95.4%、87.7%、80.6%화56.3%,분류조칙위95.8%、90.1%、86.8%화72.6%,량조차이무통계학의의(P>0.05).다원회귀분석결과현시,Child-Pugh분급시영향술후생존시간적중요인소,Child A급환자여Child B급환자적술후생존시간적차이유통계학의의(P<0.01).수방기간재출혈솔위20.9%,기중단류조22.7%,분류조18.4%,분류조1、3、5년재출혈솔명현호우단류조(P<0.05).전조간성뇌병발생솔위7.0%,기중단류조6.9%,분류조6.1%,량조차이무통계학의의(P>0.05).비신분류수술후문정맥압력、내경、류량균유현저하강(P<0.05),단잉보지향간성혈류.결론 분류술화단류술병불영향환자술후장기생존시간,유일영향인소시술전간공능Child-Pugh분급;개체화비신분류공제식관위저정맥곡장파렬출혈적료효명현호우단류수술.
Objective To retrospectively analyze the surgical outcome of portal hypertension and explore the risk-factors of long-term survival after operation. Methods The data of 149 patients(male 119, female 30,aged from 19 to 73 years old) with portal hypertension treated surgically from January 1996 to October 2007 was collected. Among these patients, there were 110 patients for Child A and 39 patients for Child B according to Child-Pugh classification. According to different surgical modality, all patients were divided into devascularization group(n=85)and shunting group(n=64). Results The follow-up rate was 78. 8% and the average follow-up time was (46. 3±30.4) months. The overall survival rates of 1-,3-,5-and 10-years were 95.6%,88.7%,83.4% and 65.1% respectively. Meanwhile the survival rates of 1-,3-,5-and 10-years in devascularization group and in shunting group were 95.4%,87.7%,80.6%,56. 3% and 95.8%,90.1%,86. 8%,72. 6% respectively. There was no significant difference in survival rate between these two groups (P > 0.05). Child-Pugh classification has been the most important risk-factor that could influence long-term survival after operation by analysis of COX regression and it showed that the long-term survival time in Child A was longer than in Child B. The rehaemorrhagia rates of 1-, 3-and 5-years in shunting group would be much better than in devascularization group. The rate of postoperative encephalopathy in devascularization group and shunting group was 6.9% and 6. 1% respectively and there was no significant difference (P > 0.05). The portal venous pressure and flow of portal vein decreased significantly after shunting operation (P < 0.05). Conclusions The mainly sole risk-factor of long-term survival for portal hypertension has been the classification of Child-Pugh, not surgical procedure. The individualized proximal splenorenal shunt is much better than devascularization in controlling variceal hemorrhagia.