CAJ | 학술논문

目的：探讨肝硬化门脉高压食管胃底静脉曲张破裂出血内窥镜治疗失败后的再手术时机。方法采用回顾性调查的方法，分析2005年1月至2010年12月48例肝硬化门脉高压症食管胃底静脉曲张破裂出血内窥镜治疗失败后再手术患者病例临床资料，根据术前内窥镜治疗次数分为A组21例，术前内窥镜治疗≤3次；B组27例，术前内窥镜治疗＞3次。比较两组病例术中、术后临床指标情况。结果 A组在胃左静脉血栓发生率、手术时间、术中出血量、断流前及断流后门静脉压力、术后并发症发生率、食管胃底静脉曲张复发率明显低于B组，B组行食管下段横断吻合术比例明显低于A组（P均＜0.05）。结论肝硬化门脉高压食管胃底静脉曲张破裂出血患者在内窥镜治疗3次失败后，应该及时进行手术治疗。
목적：탐토간경화문맥고압식관위저정맥곡장파렬출혈내규경치료실패후적재수술시궤。방법채용회고성조사적방법，분석2005년1월지2010년12월48례간경화문맥고압증식관위저정맥곡장파렬출혈내규경치료실패후재수술환자병례림상자료，근거술전내규경치료차수분위A조21례，술전내규경치료≤3차；B조27례，술전내규경치료＞3차。비교량조병례술중、술후림상지표정황。결과 A조재위좌정맥혈전발생솔、수술시간、술중출혈량、단류전급단류후문정맥압력、술후병발증발생솔、식관위저정맥곡장복발솔명현저우B조，B조행식관하단횡단문합술비례명현저우A조（P균＜0.05）。결론간경화문맥고압식관위저정맥곡장파렬출혈환자재내규경치료3차실패후，응해급시진행수술치료。
Objective To investigate the operation time after failure of endoscopic therapy of patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis. Methods The clinical data of 48 patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis between 2005 January and 2010 December which receive operation after failure of endoscopic therapy were analyzed retrospectively. According to times of preoperative endoscopic treatment, patients were divided into two groups: group A of 21 cases, which received not more than 3 times of preoperative endoscopic treatment; group B of 27 cases, which received more than three times of preoperative endoscopic treatment. Intraoperative, postoperative clinical indicators were compared between two groups. Results The rate of thrombosis of the left gastric vein, operation time, intraoperative bleeding volume, portal venous pressure of pre-devascularization and post-devascularization, the incidence of postoperative complications, esophagogastric varices recurrence rate of group A was lower than that in group B. Underwent esophageal transection of group B was significantly lower than that of group A (all P < 0.05). Conclusions Patients with esophagogastric variceal bleeding caused by portal hypertension liver cirrhosis should receive opetation after failure of endoscopic therapy not more than three times.