門靜脈高壓癥術后消化道再出血的臨床研究_《中國普外基礎與臨床雜志》

作者：

劉洪沨 , 李小毅 , 劉躍武 , 高維生

中國醫學科學院北京協和醫學院協和醫院普通外科（北京 100730）;

關鍵詞：

門靜脈高壓癥消化道再出血斷流術分流術

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目的研究門靜脈高壓癥手術后消化道再出血的原因及應對措施。
方法對2000年1月至2009年12月期間我院41例門靜脈高壓癥手術后消化道再出血患者出血原因及治療結果進行回顧分析。
結果 13例分流術后出血者均接受Phemister術；斷流手術后23例接受改良或Phemister術或擴大斷流術，5例接受腸腔分流術。術后2周內，發生手術相關并發癥共7例（17.1%），包括腹腔出血3例，消化道出血2例和難治性腹水2例。隨訪3～60個月（平均39個月），隨訪終止時均存活; 食管靜脈曲張復發3例，因食管靜脈曲張導致再出血僅1例。
結論斷流術后再出血多因術式選擇不當，分流術后再出血多與手術技巧有關；再出血后選擇適宜手術方式可取得理想治療效果。

引用本文： 劉洪沨,李小毅,劉躍武,高維生. 門靜脈高壓癥術后消化道再出血的臨床研究. 中國普外基礎與臨床雜志, 2010, 17(8): 820-823. doi: 復制

1.	高維生, 劉躍武, 趙玉沛, 等. 門靜脈高壓癥術后再出血手術方式及其療效的探討 [J]. 中華普通外科雜志, 2001; 16(7): 392394.
2.	黃莚庭. 重視對門靜脈高壓癥術后再出血的臨床診治 [J]. 中華實用外科雜志, 2001; 21(3): 129130.
3.	黃莚庭. 正確認識門靜脈高壓癥手術的個體化問題 [J]. 中華普通外科雜志, 2006; 21(5): 313314.
4.	高維生, 劉洪沨, 劉躍武, 等. 食管下段胃近端切除術治療門靜脈高壓癥上消化道出血136例分析 [J]. 中華外科雜志, 2006; 44(19): 13301332.
5.	da Silva L C, Strauss E, Gayotto LC, et al. A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis [J]. Ann Surg, 1986; 204(2): 148153.
6.	Orozco H, Mercado MA, Chan C, et al. Current role of surgery for the treatment of portal hypertension [J]. Ann Hepatol, 2002; 1(4): 175178.
7.	姜洪池. 肝硬變門靜脈高壓癥外科治療的今日思考 [J]. 中國普外基礎與臨床雜志, 2008; 15(12): 871872.
8.	GarcíaPagán JC, Villanueva C, Albillos A, et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: a multicentre randomised controlled trial [J]. Gut, 2009; 58(8): 11441150.
9.	Zipprich A, LoureiroSilva MR, D’Silva I, et al. The role of hepatic arterial flow on portal venous and hepatic venous wedged pressure in the isolated perfused CCl4cirrhotic liver [J]. Am J Physiol Gastrointest Liver Physiol, 2008; 295(1): G197G202.
10.	Groszmann RJ, GarciaTsao G, Bosch J, et al. βblockers to prevent gastroesophageal varices in patients with cirrhosis [J]. N Engl J Med, 2005; 353(21): 22542261.
11.	Thalheimer U, Mela M, Patch D, et al. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence [J]. Gut, 2004; 53(1): 143148.
12.	李震, 賈如冰, 汪忠鎬, 等. 附臍靜脈在門靜脈高壓分流術中的應用 [J]. 中國普外基礎與臨床雜志, 2010; 17(2): 180181.
13.	Mandell MS, Durham J, Kumpe D, et al. The effects of desflurane and propofol on portosystemic pressure in patients with portal hypertension [J]. Anesth Analg, 2003; 97(6): 15731577.
14.	Villanueva C, Miana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding [J]. N Engl J Med, 2001; 345(9): 647655.
15.	李震, 吳繼東, 汪忠鎬, 等. 肝前型門靜脈高壓癥的診治 [J]. 中國普外基礎與臨床雜志, 2009; 16(12): 10051009.
16.	Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage [J]. N Engl J Med, 2001; 345(9): 669681.
17.	PomierLayrargues G, Villeneuve JP, Deschênes M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial [J]. Gut, 2001; 48(3): 390396.
18.	任輝, 李志偉, 肖朝輝, 等. 門靜脈高壓癥斷流術后上消化道再出血診治體會 [J]. 中國普外基礎與臨床雜志, 2008; 15(6): 448449.
19.	Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology [J]. Gut, 2000; 46 Suppl 34: Ⅲ1Ⅲ15.
20.	Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and longterm prognosis of cirrhosis [J]. Hepatology, 2003; 37(4): 902908.
21.	Villeneuve JP, PomierLayrargues G, InfanteRivard C, et al. Propranolol for the prevention of recurrent variceal hemorrhage: a controlled trial [J]. Hepatology, 1986; 6(6):12391243.
22.	Boyer TD, Henderson JM, Heerey AM, et al. Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt [J]. J Hepatol, 2008; 48(3): 407414.
23.	GarciaPagan JC, De Gottardi A, Bosch J. Review article: the modern management of portal hypertensionprimary and secondary prophylaxis of variceal bleeding in cirrhotic patients [J]. Aliment Pharmacol Ther, 2008; 28(2): 178186.
24.	Lebrec D. Review: pharmacotherapeutic agents in the treatment of portal hypertension [J]. J Gastroenterol Hepatol, 1997; 12(2): 159166.

1. 高維生, 劉躍武, 趙玉沛, 等. 門靜脈高壓癥術后再出血手術方式及其療效的探討 [J]. 中華普通外科雜志, 2001; 16(7): 392394.
2. 黃莚庭. 重視對門靜脈高壓癥術后再出血的臨床診治 [J]. 中華實用外科雜志, 2001; 21(3): 129130.
3. 黃莚庭. 正確認識門靜脈高壓癥手術的個體化問題 [J]. 中華普通外科雜志, 2006; 21(5): 313314.
4. 高維生, 劉洪沨, 劉躍武, 等. 食管下段胃近端切除術治療門靜脈高壓癥上消化道出血136例分析 [J]. 中華外科雜志, 2006; 44(19): 13301332.
5. da Silva L C, Strauss E, Gayotto LC, et al. A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis [J]. Ann Surg, 1986; 204(2): 148153.
6. Orozco H, Mercado MA, Chan C, et al. Current role of surgery for the treatment of portal hypertension [J]. Ann Hepatol, 2002; 1(4): 175178.
7. 姜洪池. 肝硬變門靜脈高壓癥外科治療的今日思考 [J]. 中國普外基礎與臨床雜志, 2008; 15(12): 871872.
8. GarcíaPagán JC, Villanueva C, Albillos A, et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: a multicentre randomised controlled trial [J]. Gut, 2009; 58(8): 11441150.
9. Zipprich A, LoureiroSilva MR, D’Silva I, et al. The role of hepatic arterial flow on portal venous and hepatic venous wedged pressure in the isolated perfused CCl4cirrhotic liver [J]. Am J Physiol Gastrointest Liver Physiol, 2008; 295(1): G197G202.
10. Groszmann RJ, GarciaTsao G, Bosch J, et al. βblockers to prevent gastroesophageal varices in patients with cirrhosis [J]. N Engl J Med, 2005; 353(21): 22542261.
11. Thalheimer U, Mela M, Patch D, et al. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence [J]. Gut, 2004; 53(1): 143148.
12. 李震, 賈如冰, 汪忠鎬, 等. 附臍靜脈在門靜脈高壓分流術中的應用 [J]. 中國普外基礎與臨床雜志, 2010; 17(2): 180181.
13. Mandell MS, Durham J, Kumpe D, et al. The effects of desflurane and propofol on portosystemic pressure in patients with portal hypertension [J]. Anesth Analg, 2003; 97(6): 15731577.
14. Villanueva C, Miana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding [J]. N Engl J Med, 2001; 345(9): 647655.
15. 李震, 吳繼東, 汪忠鎬, 等. 肝前型門靜脈高壓癥的診治 [J]. 中國普外基礎與臨床雜志, 2009; 16(12): 10051009.
16. Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage [J]. N Engl J Med, 2001; 345(9): 669681.
17. PomierLayrargues G, Villeneuve JP, Deschênes M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial [J]. Gut, 2001; 48(3): 390396.
18. 任輝, 李志偉, 肖朝輝, 等. 門靜脈高壓癥斷流術后上消化道再出血診治體會 [J]. 中國普外基礎與臨床雜志, 2008; 15(6): 448449.
19. Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology [J]. Gut, 2000; 46 Suppl 34: Ⅲ1Ⅲ15.
20. Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and longterm prognosis of cirrhosis [J]. Hepatology, 2003; 37(4): 902908.
21. Villeneuve JP, PomierLayrargues G, InfanteRivard C, et al. Propranolol for the prevention of recurrent variceal hemorrhage: a controlled trial [J]. Hepatology, 1986; 6(6):12391243.
22. Boyer TD, Henderson JM, Heerey AM, et al. Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt [J]. J Hepatol, 2008; 48(3): 407414.
23. GarciaPagan JC, De Gottardi A, Bosch J. Review article: the modern management of portal hypertensionprimary and secondary prophylaxis of variceal bleeding in cirrhotic patients [J]. Aliment Pharmacol Ther, 2008; 28(2): 178186.
24. Lebrec D. Review: pharmacotherapeutic agents in the treatment of portal hypertension [J]. J Gastroenterol Hepatol, 1997; 12(2): 159166.

《中國普外基礎與臨床雜志》

門靜脈高壓癥術后消化道再出血的臨床研究

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《中國普外基礎與臨床雜志》

門靜脈高壓癥術后消化道再出血的臨床研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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