探讨断流术治疗肝硬化门静脉高压症患者食管胃静脉曲张的近期与远期疗效。

本前瞻性研究对象为2015年4月至2018年7月在首都医科大学附属北京佑安医院诊治的76例门静脉高压症患者。其中男43例，女33例；年龄25～65岁，中位年龄51岁。患者均签署知情同意书，符合医学伦理学规定。根据患者病情采用不同断流术，包括脾切除+选择性门奇静脉断流术、脾切除+传统断流术、脾切除术等，合并原发性肝癌（肝癌）患者同时行肝癌局部切除术。患者术后1、6、12、24个月行胃镜检查，观察术后食管胃静脉曲张变化。术前与术后各时间点食管静脉曲张程度、胃静脉曲张分型比较采用Wilcoxon秩和检验。红色征阳性率比较采用χ2检验或Fisher确切概率法。

患者均顺利完成断流术，其中行脾切除+选择性门奇静脉断流术60例，脾切除+传统断流术8例，单纯脾切除术5例，脾切除+肝癌局部切除术2例，脾切除+肝癌射频消融术1例。术后1、6、12、24个月食管静脉重度曲张患者比例分别为51%、49%、41%、35%，呈逐渐减少趋势，较术前的83%明显减少（Z =-4.786，-4.025，-4.418，-3.314；P<0.05）。食管静脉曲张红色征阳性率相应为37%、35%、33%、30%，呈逐渐下降趋势，较术前的87%明显下降（χ2=36.963，34.036，35.475，27.284；P<0.05）；而无胃静脉曲张患者比例分别为53%、60%、62%、65%;呈逐渐增加趋势，较术前的36%明显增加（Z =-1.084，-2.127，-2.608，-2.668；P<0.05）。

断流术能明显改善肝硬化门静脉高压症患者食管和胃静脉曲张的程度，其中脾切除+选择性门奇静脉断流术可能是一种较好的术式。

To investigate the short-term and long-term clinical efficacy of devascularization in the treatment of esophageal and gastric varices in cirrhosis patients with portal hypertension.

76 patients with portal hypertension admitted to Beijing Youan Hospital Affiliated to Capital Medical University from April 2015 to July 2018 were enrolled in this prospective study. Among them, 43 patients were male and 33 female, aged 25-65 years with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the conditions of patients, different devascularization procedures were performed including splenectomy + selective portal-azygos devascularization, splenectomy+traditional devascularization and splenectomy, etc. Patients complicated with primary liver cancer simultaneously underwent partial hepatectomy. All patients underwent gastroscopy at postoperative 1, 6, 12 and 24 months to observe the changes of esophageal and gastric varices. The degree of esophageal varices and classification of gastric varices at different time points before and after operation were statistically compared by Wilcoxon rank-sum test. The positive rate of red sign was statistically compared by Chi-square test or Fisher's exact test.

All patients completed the devascularization successfully, including splenectomy + selective portal-azygos devascularization in 60 cases, splenectomy + traditional devascularization in 8, splenectomy alone in 5, splenectomy + partial hepatectomy in 2 and splenectomy + radiofrequency ablation in 1, respectively. At 1, 6, 12 and 24 months after operation, the percentage of patients with severe esophageal varices was 51%, 49%, 41% and 35%, respectively, with a gradually decreasing trend, which was significantly lower than 83% before operation (Z=-4.786,-4.025,-4.418,-3.314; P<0.05). The positive rate of red sign in patients with esophageal varices was 37%, 35%, 33% and 30%, respectively, which tended to decline and was significantly lower compared with 87% before operation (χ2=36.963, 34.036, 35.475, 27.284; P<0.05). However, the positive rate in those without gastric varices was 53%, 60%, 62% and 65%, respectively, with a gradually increasing trend, which was significantly higher than 36% before operation (Z=-1.084, -2.127, -2.608, -2.668; P<0.05).

Devascularization can effectively mitigate the severity of esophageal and gastric varices in cirrhosis patients with portal hypertension. Splenectomy + selective portal-azygos devascularization may bea better option compared with the other procedures.