• 中國醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院 協(xié)和醫(yī)院普通外科（北京 100730）;

目的 研究門靜脈高壓癥手術(shù)后消化道再出血的原因及應(yīng)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(shù)后消化道再出血患者出血原因及治療結(jié)果進行回顧分析。
結(jié)果 13例分流術(shù)后出血者均接受Phemister術(shù)； 斷流手術(shù)后23例接受改良或Phemister術(shù)或擴大斷流術(shù)，5例接受腸腔分流術(shù)。術(shù)后2周內(nèi)，發(fā)生手術(shù)相關(guān)并發(fā)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(fù)發(fā)3例，因食管靜脈曲張導(dǎo)致再出血僅1例。
結(jié)論 斷流術(shù)后再出血多因術(shù)式選擇不當(dāng)，分流術(shù)后再出血多與手術(shù)技巧有關(guān)； 再出血后選擇適宜手術(shù)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(shù)后消化道再出血的臨床研究. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(8): 820-823. doi: 復(fù)制

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1. 高維生, 劉躍武, 趙玉沛, 等. 門靜脈高壓癥術(shù)后再出血手術(shù)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(shù)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(rèn)識門靜脈高壓癥手術(shù)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(shù)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(chǔ)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(shù)中的應(yīng)用 [J]. 中國普外基礎(chǔ)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(chǔ)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(shù)后上消化道再出血診治體會 [J]. 中國普外基礎(chǔ)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. 1. 高維生, 劉躍武, 趙玉沛, 等. 門靜脈高壓癥術(shù)后再出血手術(shù)方式及其療效的探討 [J]. 中華普通外科雜志, 2001; 16(7): 392394.
  2. 2. 黃莚庭. 重視對門靜脈高壓癥術(shù)后再出血的臨床診治 [J]. 中華實用外科雜志, 2001; 21(3): 129130.
  3. 3. 黃莚庭. 正確認(rèn)識門靜脈高壓癥手術(shù)的個體化問題 [J]. 中華普通外科雜志, 2006; 21(5): 313314.
  4. 4. 高維生, 劉洪沨, 劉躍武, 等. 食管下段胃近端切除術(shù)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. 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. 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. 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(chǔ)與臨床雜志, 2008; 15(12): 871872.
  8. 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. 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. 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. 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. 12. 李震, 賈如冰, 汪忠鎬, 等. 附臍靜脈在門靜脈高壓分流術(shù)中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(2): 180181.
  13. 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. 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. 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(chǔ)與臨床雜志, 2009; 16(12): 10051009.
  16. 16. Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage [J]. N Engl J Med, 2001; 345(9): 669681.
  17. 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. 18. 任輝, 李志偉, 肖朝輝, 等. 門靜脈高壓癥斷流術(shù)后上消化道再出血診治體會 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6): 448449.
  19. 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. 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. 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. 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. 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. 24. Lebrec D. Review: pharmacotherapeutic agents in the treatment of portal hypertension [J]. J Gastroenterol Hepatol, 1997; 12(2): 159166.