门静脉高压症复发性上消化道出血的精准外科治疗
安东均，张成，门定坤，周党军，王羊
摘 要
目的：探讨应用精准外科的理念，个体化选择最适合的手术方式，改善门静脉高压症复发性上消化道出血的治疗效果。
方法：回顾性分析2008年4月～2013年7月采用精准外科技术个体化治疗66例门静脉高压症复发性上消化道出血患者的临床资料。
结果：术后胃镜检查40例静脉曲张完全消失，19例基本消失，7例为轻度曲张。伴有门脉高压性胃病（PHG）的41例术后胃膜膜病变均明显改善。术后1年内再出血率6.1%（4/66）。术后肝性脑病发生率7.6%，1年、3年及5年生存率分别为97.0%（64/66）、93.3%（42/45）、85.7%（18/21）。
结论：应用精准外科技术采用个体化的术式治疗门静脉高压症复发性上消化道出血，可减少术后并发症的发生率，改善近远期疗效。
关键词
高血压；门静脉；复发性出血；精准外科；外科手术
The treatment for recurrent upper digestive tract hemorrhage with portal hypertension by precision surgical technique
AN Dongjun，ZHANG Cheng，MEN Dingkun，et al.Department of Hepatobiliary Surgery，the Center Hospital of Xianyang City，Xianyang，Shanxi 712000，China
ABSTRACT
Objective:To investigate the application of precision surgical philosophy，individual choice of the most appropriate operation，to improve the treatment effect of recurrent upper digestive tract hemorrhage with portal hypertension.
Methods:The clinical data of 66 patients who suffered from recurrent upper gastrointestinal bleeding with portal hypertension from Apr.2008 to Jul.2013 were retrospectively analyzed.
Results:Postoperative gastroscopy showed that varicose veins totally disappeared in 40 cases，basically disappeared in 19 cases，smallish varicose in 7 cases.Postoperative gastric mucosal lesions were improved obviously in 41 cases which were accompanied by portal hypertension gastropathy（PHG）.In the first postoperative year rebleeding rate was 6.1%（4/66）.After operation，the incidence of hepatic encephalopathy was 7.6%，the 1-，3-and 5 year survival rates were 97.0%（64/66），93.3%（42/45）and 85.7%（18/21）.
Conclusion:Use of precision surgical technique and personalized choice of the most appropriate operation in surgical treatment for upper digestive tract rebleeding with portal hypertension can reduce postoperative complications，improve short-term and long-term therapeutic outcomes.
KEY WORDS
portal hypertension；recurrent hemorrhage；precision surgery；surgical procedures
近年来随着现代精准外科范式的建立，已逐步实现个体化循证决策和精准化治疗［1］，精准外科策略已经融入门静脉高压症外科治疗的全过程。我科应用精准外科的理念，个体化选择最适合的手术方式治疗66例门静脉高压症复发性上消化道出血，现报道如下。