CAJ | 학술논문

目的评价改良的经胸食管横断术(Walker's术)治疗门静脉高压症术后再出血的应用价值.方法根据Sugiura术的血液动力学原理,将经胸食管横断术进行改良(改良Walker's术).在食管下段较低位置阻断食管静脉血流的同时,离断腹段曲张静脉残留或复发的冠状静脉属支.结果本组患者共53例,择期手术49例,无手术死亡；急症手术4例,1例术后死于肝功能衰竭.本组中5例失访,有48例获得长期随访,在术后1年5个月因肝功能衰竭死亡1例,术后2～3年2例死于肝癌,术后4～5年3例因肝功能衰竭、肝肾综合征死亡.存活5年以上者有41例,5年生存率为77％.1例患者再手术后已生存24年.结论改良Walker's术操作简单、容易掌握、节省时间、止血可靠,适应证宽.近期、远期止血效果良好,可普遍地应用于门静脉高压症术后再出血患者.
목적 평개개량적경흉식관횡단술(Walker's술)치료문정맥고압증술후재출혈적응용개치.방법 근거Sugiura술적혈액동역학원리,장경흉식관횡단술진행개량(개량Walker's술).재식관하단교저위치조단식관정맥혈류적동시,리단복단곡장정맥잔류혹복발적관상정맥속지.결과 본조환자공53례,택기수술49례,무수술사망；급증수술4례,1례술후사우간공능쇠갈.본조중5례실방,유48례획득장기수방,재술후1년5개월인간공능쇠갈사망1례,술후2～3년2례사우간암,술후4～5년3례인간공능쇠갈、간신종합정사망.존활5년이상자유41례,5년생존솔위77％.1례환자재수술후이생존24년.결론 개량Walker's술조작간단、용역장악、절성시간、지혈가고,괄응증관.근기、원기지혈효과량호,가보편지응용우문정맥고압증술후재출혈환자.
Objectives To evaluate modified transthoracic esophageal transection (modified Walker's procedure) for management of postoperative rebleeding of portal hypertension.Methods Since 1983,we adopted modified Walker's operation to make low esophageal transection and transect intraabdominal recurrent varix of the coronary vein in the treatment of esophageal variceal rebleeding in portal hypertensive patients who had received previous surgeries aiming at portal hypertension.Results In 53 cases of postoperative rebleeding of portal hypertension,49 cases underwent elective operation with no mortality,4 cases received emergency surgery,one died post-operatively due to hepatic failure.The postoperative control rate of recurrent bleeding was 100％,and the overall postoperative mortality was 2％.The longest postoperative survival time was 24 years,and the 5-year survival rate was 77％.There were no postoperative recurrent hemorrhage and hepatic encephalopathy.Conclusions Modified transthoracic esophageal transection (modified Walker's procedure) is easy to perform,good at saving operative time,with a reliable immediate hemostatic effect and long-term control of variceal hemorrhage,hence is a effective remedy operative method for postoperative rebleeding of portal hypertensive patients after failed previous operations.