Galambos J T, Warren W D, Rudman D, Smith R B, Salam A A
N Engl J Med. 1976 Nov 11;295(20):1089-95. doi: 10.1056/NEJM197611112952001.
Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In two of the latter, a total shunt had to be performed for technical reasons. The fatality rates (six in the 24 total, and six in 22 selective [performed], and seven in 24 selective [randomized]), the frequency of shunt occlusion (two in each group), and of recurrent gastronintestinal bleeding (three in each group) were similar. Encephalopathy developed more often after a total shunt -- 10 of 24, or one per 58 patient-months -- than after selective (performed) -- one of 22, or one per 593 patient-months (P less than 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P less than 0.05).
通过一项随机对照试验，对48例食管静脉曲张出血患者的两种手术治疗方法进行了评估：24例被随机分配接受全分流术，24例接受选择性分流术。在接受选择性分流术的患者中，有2例因技术原因不得不改为全分流术。全分流术组死亡6例（共24例），选择性分流术组（实际接受手术的22例）死亡6例，选择性分流术组（随机分组的24例）死亡7例；分流闭塞频率（每组2例）和胃肠道出血复发频率（每组3例）相似。与选择性分流术（实际接受手术的22例中有1例，即每593患者月1例）相比，全分流术后脑病发生率更高——24例中有10例，即每58患者月1例（P<0.005）。全分流术持续使向肝的肠系膜-门静脉血流从肝脏分流。全分流术后肝功能恶化（尿素合成最大速率）比选择性分流术更严重（P<0.05）。
