分流、断流与减流三联合术治疗门静脉高压性上消化道出血
安东均 苏旅明
摘 要
目的：针对导致门静脉高压性上消化道出血的2种基本因素——食管胃底静脉曲张破裂及门静脉高压性胃病，探讨一种两者兼治的、行之有效的手术方法。
方法：用改良脾肾分流、门奇断流加肠系膜上动脉减流术，对23例门静脉高压性消化道出血进行外科治疗，对这一手术方法进行总结。
结果：术后再出血率为4.3%，肝性脑病发生率为8.7%，肝功能明显改善占78.3%。术后纤维胃镜显示所有门静脉高压性胃病患者黏膜特征性的樱桃红斑迅速消退，食管胃底静脉曲张状况均有不同程度减轻。
结论：三联手术对2种因素导致的门静脉高压性上消化道出血兼而治之，较单一手术具有优势互补、扬长补短之优点。该手术适应证广、操作简单，近远期疗效满意。
关键词
高血压；门静脉；脾肾分流术；外科手术
Treatment of upper gastrointestinal hemorrhage due to portal hypertension by triple operation:shunt and devascularization with flow reduction
ABSTRACT
Objective:In view of the two basic factors leading to portal hypertensive upper gastrointestinal hemorrhage-esophageal and gastric fundus varices rupture and portal hypertensive gastropathy，an effective surgical method of treating both is discussed.
Methods:23 cases of gastrointestinal hemorrhage due to portal hypertension were treated surgically with modified splenorenal shunt，portal azygos disconnection and superior mesenteric artery subtraction，and this surgical method was summarized.
Results:The postoperative rebleeding rate was 4.3%，the incidence rate of hepatic encephalopathy was 8.7%，and the liver function significantly improved accounted for 78.3%.Postoperative fiberogastroscopy showed that cherry erythema characteristic of mucosa in all patients with portal hypertensive gastropathy rapidly subsided，and esophageal and gastric varices were alleviated to varying degrees.
Conclusion:Triple surgery can treat portal hypertension-induced upper gastrointestinal hemorrhage caused by two factors simultaneously.Compared with single surgery，triple surgery has the advantages of complementary advantages and strong points.The operation has wide indications，simple operation and satisfactory short-term and longterm effects.
KEY WORDS
Hypertension ；Portal ；Splenic Renal Shunt；Surgery
近年来研究表明食管胃底曲张静脉破裂和门静脉高压性胃病（Portal hypertensive gastro pathy，PHG）是门静脉高压性上消化道出血的2个基本因素，同时认为在治疗上断流术与分流术均存在着严重缺点。为此自1995年4月～1999年6月我们设计了改良的脾肾分流、门奇断流加肠系膜上动脉减流联合手术治疗23例门静脉高压性上消化道出血，现就临床疗效报告如下。