發(fā)布時(shí)間：2018-04-26 06:40

  本文選題：聯(lián)合斷流術(shù) + 賁門周圍血管離斷術(shù)�。� 參考：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:比較聯(lián)合斷流術(shù)和賁門周圍血管離斷術(shù)治療肝硬化門靜脈高壓癥的療效及術(shù)后臨床特點(diǎn),探討合理術(shù)式的選擇,總結(jié)臨床經(jīng)驗(yàn)。方法:通過回顧性分析大連醫(yī)科大學(xué)附屬第一臨床醫(yī)院及第二臨床醫(yī)院普外科1996年1月到2012年1月收治的因肝硬化門靜脈高壓癥行賁門周圍血管離斷術(shù)或聯(lián)合斷流術(shù)患者的臨床資料160例。根據(jù)手術(shù)方式不同分為聯(lián)合斷流術(shù)組(觀察組)80例和賁門周圍血管離斷術(shù)組(對(duì)照組)80例。比較兩組手術(shù)時(shí)間、禁食時(shí)間、急診止血率、術(shù)后1個(gè)月內(nèi)并發(fā)癥發(fā)生率、術(shù)后1個(gè)月食管胃底靜脈曲張消除率、隨訪術(shù)后2年內(nèi)上消化道出血率及死亡率指標(biāo)。所有數(shù)據(jù)均應(yīng)用SPSS17.0軟件進(jìn)行處理。其中計(jì)量資料以平均數(shù)±標(biāo)準(zhǔn)差形式表示,符合正態(tài)分布的組間比較采用T檢驗(yàn)(t-test)分析;計(jì)數(shù)資料以例數(shù)或百分比描述,組間比較采用X2檢驗(yàn)分析。以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:對(duì)觀察組和對(duì)照組術(shù)前觀察指標(biāo)性別、年齡、病因、出血史、手術(shù)時(shí)機(jī)、白細(xì)胞計(jì)數(shù)(WBC)、血小板計(jì)數(shù)(PLT)、血紅蛋白(HGB)、門靜脈寬度、Child-Pugh分級(jí)、食管胃底靜脈曲張程度的兩兩對(duì)應(yīng)比較,所有術(shù)前觀察指標(biāo)比較無明顯差異(P0.05)。對(duì)兩組患者術(shù)中及術(shù)后觀察指標(biāo)比較,其中兩組術(shù)后急診止血率、術(shù)后1個(gè)月內(nèi)并發(fā)癥發(fā)生率及術(shù)后2年內(nèi)死亡率的比較無明顯差異(P0.05),其余手術(shù)時(shí)間、術(shù)后禁食時(shí)間、術(shù)后1個(gè)月食管胃底靜脈曲張消失率、術(shù)后2年內(nèi)上消化道出血率指標(biāo)的比較在存在差異(P0.05)。觀察組手術(shù)時(shí)間232.08±64.24min,禁食時(shí)間5.38±1.36d,術(shù)后1個(gè)月食管胃底靜脈曲張消失率90%,術(shù)后2年內(nèi)上消化道出血率3.4%。對(duì)照組手術(shù)時(shí)間211.38±59.36min,禁食時(shí)間4.56±1.33d,術(shù)后1個(gè)月食管胃底靜脈曲張消失率72%,術(shù)后2年內(nèi)上消化道出血率15%。觀察組手術(shù)時(shí)間和術(shù)后禁食時(shí)間長(zhǎng)于對(duì)照組,觀察組術(shù)后1個(gè)月食管胃底靜脈曲張消失率高于對(duì)照組,觀察組術(shù)后2年內(nèi)上消化道出血率低于對(duì)照組。結(jié)論:1.在治療肝硬化門靜脈高壓癥方面,聯(lián)合斷流術(shù)與賁門周圍血管離斷術(shù)均能夠達(dá)到急診EGVB時(shí)止血和術(shù)后消除EGV的目標(biāo),治療效果明確。2.賁門周圍血管離斷術(shù)較聯(lián)合斷流術(shù)手術(shù)時(shí)間短、術(shù)后禁食時(shí)間短,更適合急診手術(shù)。3.聯(lián)合斷流術(shù)較賁門周圍血管離斷術(shù)術(shù)后近期EGV消除率高、中期上消化道出血率低,近期及中期療效更好,比較適合擇期手術(shù)。
[Abstract]:Objective: to compare the efficacy and clinical characteristics of combined devascularization and pericardial devascularization in the treatment of cirrhotic portal hypertension. Methods: from January 1996 to January 2012, the patients with cirrhotic portal hypertension treated in the first Clinical Hospital and the second Clinical Hospital of Dalian Medical University underwent pericardial devascularization or combined devascularization. Clinical data of 160 patients undergoing flow surgery. According to the different operation methods, the patients were divided into two groups: the observation group (n = 80) and the control group (n = 80). The operative time, fasting time, emergency hemostasis rate, complication rate within 1 month, esophageal and gastric varices elimination rate, upper gastrointestinal bleeding rate and mortality index were compared between the two groups. All data are processed by SPSS17.0 software. The measurement data are expressed in the form of mean 鹵standard deviation, T test t-test) is used to analyze the comparison between groups in accordance with normal distribution, and the counting data is described as an example or percentage, and the comparison between groups is analyzed by X2 test. P0.05 as the difference was statistically significant. Results: sex, age, etiology, bleeding history, operation time, white blood cell count, platelet count, hemoglobin HGBG, portal vein width and Child-Pugh grade were observed before operation in the observation group and control group. There was no significant difference in all preoperative indexes of esophageal and gastric varices (P 0.05). There was no significant difference in the rate of emergency hemostasis, the incidence of complications within one month and the death rate within 2 years after operation between the two groups. There was no significant difference between the two groups (P 0.05). The rest of the operative time and the time of fasting after operation were not significantly different between the two groups. The rate of esophageal and gastric varices disappeared 1 month after operation, and the index of bleeding rate of upper digestive tract within 2 years after operation was different (P 0.05). In the observation group, the operative time was 232.08 鹵64.24 min, the fasting time was 5.38 鹵1.36 days, the esophageal and gastric fundus varices disappeared at 1 month after operation, and the upper gastrointestinal bleeding rate was 3.4% within 2 years after operation. In the control group, the operative time was 211.38 鹵59.36 min, the fasting time was 4.56 鹵1.33 days, the esophageal and gastric fundus varices disappeared at 1 month after operation, and the bleeding rate of upper digestive tract was 15 times within 2 years after operation. The operative time and fasting time were longer in the observation group than in the control group. The disappearance rate of esophageal and gastric varices in the observation group was higher than that in the control group 1 month after operation. The bleeding rate of upper digestive tract in the observation group was lower than that in the control group within 2 years after operation. Conclusion 1. In the treatment of cirrhotic portal hypertension combined with devascularization and pericardial devascularization can reach the goal of hemostasis in emergency EGVB and the elimination of EGV after operation. Pericardial devascularization is more suitable for emergency operation than combined devascularization. The combined devascularization was more effective than pericardial devascularization in recent EGV elimination rate, lower upper gastrointestinal bleeding rate in the middle stage, better short-term and medium-term curative effect, and more suitable for selective operation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3

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