引用本文:白 杨,俞世安,许龙堂,龚道军,於 敏,丁 进,胡晓钢.三种微创方式治疗门静脉高压上消化道出血73例临床分析[J].中国临床新医学,2019,12(1):28-31.
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三种微创方式治疗门静脉高压上消化道出血73例临床分析
白 杨,俞世安,许龙堂,龚道军,於 敏,丁 进,胡晓钢
310000 杭州,浙江大学医学院普外科(白 杨);321000 金华,浙江大学金华医院肝胆胰外科(白 杨,俞世安,许龙堂),胃肠疝外科(龚道军,於 敏),消化科(丁 进),介入科(胡晓钢)
摘要:
[摘要] 目的 比较三种微创方式治疗门静脉高压急性上消化道出血的止血效果及并发症情况,为临床选择合适治疗方式提供参考。方法 收集浙江大学金华医院2013-02~2017-12因门静脉高压导致急性上消化道出血入院的患者共73例,依据治疗方式不同分为腹腔镜组(16例)、内镜组(31例)、经颈静脉肝内门体分流术(TIPS)组(26例),比较三组患者的一般情况、术后住院时间、术后并发症、围术期死亡情况及术后再出血情况。结果 内镜组平均住院时间最短(P<0.05),住院费用最少(P<0.05),腹腔镜组术后腹腔感染发生率最高(P<0.05),TIPS组术后肝性脑病发生率最高(P<0.05),腹腔镜组再出血率最低(P<0.05)。结论 三种微创方式治疗门静脉高压急性上消化道出血各有优势,应综合考虑患者情况、医师的经验以及医院的技术条件,选择合适的治疗方法。
关键词:  门静脉高压  上消化道出血  微创治疗
DOI:10.3969/j.issn.1674-3806.2019.01.07
分类号:R 657.3+4
基金项目:浙江省医药卫生科技计划项目(编号:2018ZD052)
Clinical analysis of three minimally invasive methods for treatment of upper gastrointestinal bleeding caused by portal hypertension in 73 cases
BAI Yang, YU Shi-an, XU Long-tang, et al.
Department of General Surgery, Medical School of Zhejiang University, Hangzhou 310000, China
Abstract:
[Abstract] Objective To compare the hemostatic effects and complications of three minimally invasive methods in treatment of acute upper gastrointestinal bleeding caused by portal hypertension, and to provide the reference for selection of suitable treatment methods for clinical practice. Methods The clinical data of 73 patients with acute upper gastrointestinal hemorrhage caused by portal hypertension were collected in Jinhua Hospital of Zhejiang University between February 2013 and December 2017. These patients were divided into laparoscopic group(n=16), endoscopic group(n=31) and TIPS group(n=26) according to different treatment methods. The general situation, postoperative hospitalization time, postoperative complications, perioperative death and postoperative rehemorrhage were retrospectively analyzed and compared among the three groups. Results The endoscopic group had the shortest average time of hospitalization(P<0.05) and the lowest hospitalization cost(P<0.05), and the incidence of obdominal infection after operation in the laparoscopie group was the highest(P<0.05). The incidence of hepatie encephalopathy after operation in the TIPS group was the hightest(P<0.05). The laparoscopie group had the lowest rebleeding rate(P<0.05). Conclusion The three methods have their respective advantages in the treatment of acute upper gastrointestinal bleeding caused by portal hypertension, as a result, an appropriate treatment method should be selected based on the comprehensive consideration of the patient′s condition, the doctor′s experience and the technical conditions of the hospital.
Key words:  Portal hypertension  Upper gastrointestinal hemorrhage  Minimally invasive treatment