摘要
目的研究门静脉高压症（PHT）患者消化道出血的时间、临床特点及其对断流术疗效的影响。方法1993年1月-2008年11月收治门静脉高压症患者270例，均经断流术治疗，根据术前有无消化道出血病史分为有出血组和无出血组，对两组间消化道溃疡病史、胆石症病史、食管胃底静脉曲张程度、出血到手术治疗时间以及不同时机的手术疗效等临床资料进行回顾性对比分析。结果经Logistic回归分析显示，性别、食管胃底静脉曲张程度、红色征及术前PLT计数等四项指标在有出血组与无出血组之间的综合效应有统计学意义（x^2=71．707，P=0．000）。住院时间：出血组（37．6±17．24）天与无出血组（31．6±13．01）天比较差异有统计学意义（P〈0．01）；有出血组术中出血量、自由门静脉压降幅、术后多项肝功能指标、术后并发症发生率、手术死亡率等与无出血组比较无明显差异。有出血组中出血1年以上者住院时间、术后自由门静脉压降幅、术后并发症的发生率及术后近期死亡率与出血1年以内者比较，差异均有统计学意义（P〈0．05）。结论1．PHT患者消化道出血的高危因素为：①食管胃底中重度静脉曲张，②男性，③红色征，④术前PLT计数〈50×10^9／L。2．消化道出血病史本身对断流术疗效的影响不大，建议具有包括①在内的高危因素时施行预防性断流术治疗。3．对于已发生消化道出血的PHT患者，手术时机选择在首次出血后1年内为宜。
Objective To select the right time to perform devascularization for variceal heamorrhage due to portal hypertension. Methods The clinical data of 270 patients with portal hypertension from Jan 1993 to Nov 2008 underwent devascularization were retrospectively analyzed. All the patients were divided into heamorrhage and non-heamorrhage groups according to the history of variceal heamorrhage. Patients who suffered varicael heamorrhage were further divided into two groups （ within 1 year group and beyond 1 year group） according to the time untill they received operation from the first heamorrhage. Results Logistic regression analysis showed that gender, degree of varication, red-color sign and blood platelets count （pre-operatian）were significantly different between hemorrrhage and non-hemorrhage group（ x^2 = 71. 707, P = 0. 000 ）. The length of hospital stay between hemorrrhage group （ 37.6 ± 17. 24, d） and non-hemorrhage group （31.6±13.01, d）were different （P 〈 0. 01 ）. There were no difference between the two groups of the amount of blood loss, the decrease amplitude of free portal pressure, the levels of ALT, AST, ALB, Tbi, DBi （ pre-operation）, the incidence of postoperative early complications and the death rate. The length of stay, the decrease amplitude of free portal pressure, the incidence of postoperative early complications and the death rate were different between within 1 year group and beyond 1 year group （P 〈 0. 05）. Conclusion The risk factors of variceal heamorrhage in patients with portal hypertension are degree of varication, gender, red-color sign and blood platelets count. Patients with risk factor（s） including degree of varication should receive prophylactic devascularization. It is sugestted to practice devascularization for patients those who have already hemorrhead within 1 year since the first variceal heamorrhage.
出处
《肝胆外科杂志》
2009年第6期415-418,共4页
Journal of Hepatobiliary Surgery
关键词
门静脉
高血压
断流术
消化道出血
Portal hypertension
Devascularization
Varieeal heamorrhage
