摘要
目的分析选择性断流术后门静脉压力梯度（portal pressure gradient，PPG）的改变与门静脉高压症患者术后并发症及远期疗效的关系，探讨PPG在评价患者再出血中的作用。方法收集135例行选择性断流术门静脉高压症患者的临床资料，测量切脾前与断流术后PPG的变化，并与其术后并发症及远期疗效作统计学分析。结果本组135例门静脉高压症患者均接受断流手术治疗，术后死亡2例（1．5％）。依据断流术后PPG〈12mmHg、PPG≥12mmHg但与切脾前比较至少下降20％、PPG≥12mmHg但与切脾前比较下降〈20％将患者分为3组，分别为62例、41例和32例。3组术后并发症发生率之间相比差异无统计学意义（P〉0．05）。3组1、2、3年累计未出血率分别为100％：100％：95％、100％：97％：90％、100％：93％：87％，3组之间相比差异均有统计学意义（x^2=6．859，P=0．032）。COX风险回归亦显示PPG是影响门静脉高压症患者术后上消化道出血复发的独立因素（P=0．002）。3组1、2、3年累计生存率分别为100％：100％：94％、98％：95％：92％、97％：93％：88％，3组之间相比差异均无统计学意义（X^2=2．917，P=0．233）。结论选择性断流术后PPG变化是门静脉高压症患者上消化道出血复发的一项预测指标，但不是生存率的一项预后指标。
Objective To investigate the relationship between the changes of portal pressure gradient after selective devascularization with postoperative complications and recurrent bleeding of gastroesophageal varix in patients of portal hypertension. Methods The clinical data of 135 cases of portal hypertension undergoing selective devascularization was collected. Portal pressure gradient was measured before splenectomy and after selective devascularization, and was analyzed against postoperative complications and recurrent bleeding. Results In this study, 135 patients of portal hypertension underwent selective devascularization, two cases died during perioperative period （1.5%）. Postoperatively patients were divided into three groups based on PPG 〈 12 mm Hg after selective devascularization （62 cases）, HVPG ≥ 12 mm Hg but a more than 20% of decrease off the pre-splenectomy baseline （41 cases） and HVPG ≥ 12 mm Hg with less than 20% of decrease from the baseline （32 cases）. The postoperative complications between the three groups were of no significant difference （P 〉 0. 05 ）. The 1,2, 3 year cumulative rate of no variceal rebleeding of the three groups were 100% vs. 100% vs. 95% ; 100% vs. 97% vs. 90%; and 100% vs. 93% vs. 87% （X^2=6. 859, P =0.032）. COX regression analysis indicated portal vein pressure gradient was an independent prognostic factor of variceal bleeding recurrence （P =0. 002）. 1,2,3 year cumulative survival rates of the three groups were 100% vs. 100% vs. 94% ; 98% vs. 95% vs. 92% ; 97% vs. 93% vs. 88% , there were no significant difference among the three groups （X^2 = 2. 917, P = 0. 233 ）. Conclusions The decrease in the PPG after selective devascularization is a predictor for the risk of rebleeding but not for survival after selective devascularization.
出处
《中华普通外科杂志》
CSCD
北大核心
2011年第2期116-119,共4页
Chinese Journal of General Surgery
基金
杭州市科技发展计划基金资助（20080333Q12）
关键词
门静脉压
胃肠出血
食管和胃静脉曲张
断流术
Portal pressure
Gastrointestinal hemorrhage
Esophageal and gastric varices
Devascularization
