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目的探讨贲门周围血管离断术加胃底血管横断术应用于晚期血吸虫病(晚血)门静脉高压症患者的效果。方法选择阳新县第三人民医院自2006年以来实施贲门周围血管离断加胃底血管横断术的36例晚血患者(胃底血管横断组),以及同期采用改良Sugiura术进行治疗的10例晚血患者(改良Sugiura组)作为观察对象,比较两类患者的临床疗效。结果胃底血管横断组患者手术时间、胃管留置时间、术后进食时间、引流管拔除时间均短于改良Sugiura组,差异均有统计学意义(P均<0.05),两组住院费用分别为(25 466.00±2 888.48)元和(34 517.10±4 948.39)元,差异亦有统计学意义(P<0.05)。术后胃底血管横断组和改良Sugiura组门静脉血栓发生率分别为33.33%(12/36)和40.00%(4/10),两组术后12个月再出血发生率分别为16.67%(6/36)和10.00%(1/10),差异均无统计学意义(P均>0.05);改良Sugiura组出现1例胃排空障碍和1例食管吻合口漏,胃底血管横断组无相应并发症发生。结论贲门周围血管离断加胃底血管横断术操作相对简单,近期临床效果较好,适用于基层医院,但其远期效果还有待进一步观察。
Objective To investigate the effect of pericardial devascularization and gastric vascular transection on advanced schistosomiasis (late blood) patients with portal hypertension. Methods 36 cases of late blood (gastric fundus vascular transection group) were performed in the Third People’s Hospital of Yangxin County since 2006, and peri-cardiac vascular disconnection and gastric vascular transection were performed. Ten patients were treated with modified Sugiura operation at the same period Blood patients (modified Sugiura group) as the observation object, the clinical efficacy of two types of patients were compared. Results The operation time, gastric tube indwelling time, postoperative feeding time and drainage tube removal time in patients with gastric fundus transection were shorter than those in the modified Sugiura group (all P <0.05). The hospitalization costs of the two groups were (25 466.00 ± 2 888.48) yuan and (34 517.10 ± 4 948.39) yuan, the difference was also statistically significant (P <0.05). The incidence rates of portal vein thrombosis in gastric fundus vascular bypass group and modified Sugiura group were 33.33% (12/36) and 40.00% (4/10) respectively. The incidence of rebleeding 12 months after operation was 16.67% (6 / 36) and 10.00% (1/10), respectively, with no significant difference (all P> 0.05). There was one case of gastric emptying failure and one case of esophageal anastomotic leakage in the modified Sugiura group, Complications occur. Conclusions Periocardial vascular disconnection plus gastric fundus transection is relatively simple and has good clinical effect recently. It is suitable for primary hospitals, but its long-term effect needs to be further observed.