治疗门脉高压症上消化道出血的术式改进

本文报告了采用改良式脾肾分流术，胃内、胃外断流术，选择性门奇断流，贲门周围腹膜化治疗门脉高压症上消化道出血５９例。手术特点分别为腹主动脉前行脾肾静脉端侧吻合术；胃内、胃外联合断流，完全切断门静脉和奇静脉之间进入胃、食管的分支静脉；选择性门奇断流后将胃底部向上反折包绕贲门部，使贲门周围腹膜化，不易发生胃壁缺血坏死和再出血。经随访提示以上术式治疗门脉高压症上消化道出血，止血效果满意。

TREATMENT OF BLEEDING GASTROESOPHAGEAL VARICE BY MODIFIED OPERATIVE PROCEDURES

The treatment of 59 cases of bleeding gastroesophageal varices due to theportal hypertension by the modified procedures included renal-splenic venous shunt with endto-side anastomosis, selective porta-azygous devascularization,transgastric ligation ofgastric varices and pericardial peritonization is reported in this paper. The charecteristics ofthese procedures were as follows:①The renal-splenic venous shunt was performed in frontof the abodminal aorta;②Both internal and external varices of the stomach weredisconnected,the communicating branches of the portal and azygous veins which entered intothe stomach and lower end of the esophagus were cut off completely;③The operated areawere enbeded by the fundus of the stomach to prevent ischemic necrosis of the cardiacportion of the stomach and recurrent bleeding. The follow-up results showed that these procedures were effective to stop bleedingcaused by the gastroesophageal varices due to the portal hypertension.