门脉高压症贲门周围血管离断术不必附加幽门成形术

武书胜　管强　王殿臣

　　摘要：目的：探讨肝硬化门脉高压症病人行脾切除贲门周围血管离断术附加幽门成形术的必要性并观察保留迷走神经对胃排空功能恢复的影响。方法：观察肝硬化门脉高压症病人行脾切除贲门周围血管离断术双侧迷走神经主干切断组与保留迷走神经或附加幽门成形术组胃排空功能恢复情况。结果：双侧迷走神经主干切断组胃排空功能恢复平均时间5.2d，附加幽门成形术或保留迷走神经组分别为4.2d和4.1d。前者发生胃潴留2/36(6％)例，但均于短时间内恢复；后者未见胃潴留发生。结论：认为贲门周围血管离断术附加幽门成形术非为必需，术中保留迷走神经确属有益。
　　关键词：门脉高压症；贲门周围血管离断术；胃潴留；迷走神经
　　中图分类号：R657.3＋4　　文献标识码：A
文章编号：1006－8716(2000)02－0105－02

To observe the gastric emptying of patient with portal hypertesion after D.P.D

WU Shu-sheng， GUAN Qiang， WANG Dian-chen
(The People’s Hospital of Shanxi Provinces.Taiyuan 030012，China)

　　Abstract：Objective：To explore the necessity of splenectomy and D.P.D procedures with pyloroplasty for patients with L.C and portal hypertesion，and to observe the influence of the function of gastric emptying with vagus were kept.Methods：To observe the resume of gastric emptying of different groups of patients with L.C and portal hypertesion，one group were underwent splenectomy and D.P.D procedures with both vagotomy，and the other one’s vagus were kept with or without pyloroplasty.Result：The average time of the resume of gastric emptying for the group of both vagotomy is 5.2days，and 4.2days for the former with pyloroplasty，4.1days for the patients of vagus kept.2 in 36 cases suffered from stomach tarry in the former way are resumed in a short time，and none occurs with stomach tarry in the later.Conclusion：D.P.D with pyloroplasty isn’t necessary，but D.P.D with vagus kept do benefit.
　　Key words：portal；hypertesion pyloroplasty；stomach tarry； vagus

　　对于门脉高压症的手术治疗，贲门周围血管离断术为其常用术式，其经典术式多切断双侧迷走神经主干，为预防术后出现胃潴留，常附加幽门成形术，而致手术扩大、时间延长并增加污染和并发症发生机会。作者观察本院肝硬化门脉高压症病人行贲门周围血管离断术56例，试图评价几种术式对胃排空功能的影响。
1　临床资料
　　1994年～1998年肝硬化门脉高压症病人56例，男31例，女25例，平均年龄43.2岁。均行脾切除加贲门周围血管离断术，其中附加幽门成形术者9例，保留迷走神经者11例。胃潴留定义为因胃排空障碍而留置胃管≥7d，或恢复流质饮食后再出现胃潴留症状。以胃液日引流量少于300mL，不含胆汁，无腹胀呕吐，肠鸣音正常并能耐受流质饮食为胃功能恢复拔除胃管之指征，有其它明确影响胃排空功能的并发症发生者除外。双侧迷走神经主干切断未附加幽门成形术者发生胃排

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