探讨疏堵结合断流术治疗肝硬化门静脉高压症患者食管静脉曲张破裂出血的临床疗效。

回顾性分析2008年1月至2018年1月在中山大学附属第三医院、中山大学附属第三医院粤东医院行手术治疗的54例肝硬化门静脉高压症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男37例，女17例；年龄37～52岁，中位年龄45岁。根据手术方式将患者分为疏堵结合断流组（22例）和选择性断流组（32例）。两组患者围手术期自由门静脉压力（FPP）及胃底贲门区静脉压力比较采用t检验，术后并发症发生率比较采用χ²检验。

疏堵结合断流组与选择性断流组术后的FPP分别为（22±5）、（22±7） mmHg （1 mmHg=0.133 kPa），较术前的（32±4）、（31±5）mmHg明显降低（t=-17.21，-22.54；P<0.05）；胃底贲门区静脉压力为（18±7）、（20±3）mmHg，亦较术前的（30±5）、（29±3）mmHg明显降低（t=-13.39，-20.44；P<0.05）。两组术后胃底贲门区静脉压力、FPP差异无统计学意义（t=1.44，0.95；P>0.05）。疏堵结合断流组静脉曲张复发率及门静脉高压性胃病发生率分别为9%、18%，明显低于选择性断流组的28%、31%（χ²=5.31，4.89；P<0.05）。疏堵结合断流组和选择性断流组再出血率分别为4%、3%，差异无统计学意义（χ²=0.21，P>0.05）。

与选择性断流相比，疏堵结合断流术治疗食管胃底静脉曲张破裂出血疗效相似，且具有术后静脉曲张复发率、门静脉高压性胃病发生率低的优势。

To evaluate the clinical efficacy of bypass combined with devascularization in the treatment of esophageal variceal bleeding in patients with cirrhotic portal hypertension.

Clinical data of 54 patients with cirrhotic portal hypertension who underwent surgery in the Third Affiliated Hospital of Sun Yat-sen University and Yuedong Hospital of the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 54 patients, 37 cases were male and 17 female, aged from 37 to 52 years with a median age of 45 years. According to the operation procedure, the patients were divided into bypass combined with devascularization group (BD group, n=22) and selective devascularization groups (SD group, n=32). The perioperative free portal vein pressure (FPP) and the venous pressure at the gastric fundus and cardiac region (GCP) were compared by t test. The incidence of postoperative complications was compared by Chi-square test.

In BD and SD groups, the FPP was (22±5) and (22±7) mmHg (1 mmHg=0.133 kPa) respectively, significantly lower than the preoperative FPP (32±4) and (31±5) mmHg (t=-17.21, -22.54; P<0.05); The GCP was (18±7) and (20±3) mmHg respectively, significantly lower than (30±5) and (29±3) mmHg before surgery (t=-13.39, -20.44; P<0.05). No significant difference was observed in the postoperative GCP and FPP between two groups (t=1.44, 0.95; P>0.05). In BD group, the recurrent rate of esophageal varices and incidence of portal hypertensive gastropathy was 9% and 18% respectively, significantly lower than 28% and 31% in SD group (χ2=5.31, 4.89; P<0.05). The incidence of rebleeding in BD group was 4% and was 3% in SD group, where no significant difference was observed (χ2=0.21, P>0.05).

Compared with selective devascularization, the combination of bypass and devascularization in treating esophageal variceal bleeding yields similar clinical efficacy, and has the advantages of lower postoperative recurrent rate of esophageal varices and incidence of portal hypertensive gastropathy.