Abstract:Objective：To explore the treatment efficacy of combined esophageal transection and anastomosis with stapler and portoazygous devascularization (P-AD) in treatment of ruptured osophagogastric varlces and bleeding.
Methods ：One hundred and tweenty patients with portal hypertension and ruptured esophagogastric varices with massive hemorrhage who treated in our hospital from Mar 1998 to Dec 2001 were divided into two groups randomly. Each group had 60 patients. The patients in the combined devascularization group were operated by P-AD and transabdominal esophageal transection and reanastomosis with stapler; and the patents in the control group were operated by P-AD only. The short-term complications and long-term follow-up results were observed and compared.
Results：The incidence rate of postoperative complications showed no significant difference between the two groups.(P>0.05); the disappearance rate of varices of fundus of stomach and esophagus in the combined devascularization group was higher than that in control group(P<0.01). The re-bleeding rate in the combined devascularization group was less than that in control group (P<0.05). Liver function of the patients in the two groups improved post-operatively, and no significant difference was found between the two groups (P>0.05). The long-term （fourth to seventh year）survived rate of the combined devascularization group was higher than that of control group (98.3% in the combined devascularization group, 90.0% in control group) (P<0.05).
Conclusions：The combined devascularization operation has more effective in treating esophagogastric varices, and can reduce the rate of rebleeding, improve the treatment effect of P-AD.