Johansen K
Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle.
Surg Gynecol Obstet. 1992 Dec;175(6):528-34.
Eighty-six patients underwent portacaval shunt (PCS) to treat bleeding esophagogastric varices during a period of four years. Twenty-eight patients (group 1) underwent emergency total portal decompression, while 58 patients (group 2) underwent elective partial PCS. Age, gender, preshunt and postshunt alcohol consumption and modified Child-Pugh classification at the time of operation, and at latest follow-up evaluation, did not differ significantly between the two groups. Early mortality was higher after emergency shunts than after elective operation (p < 0.01). However, partial portal decompression, when compared with total shunt, resulted in a significantly lower likelihood of late mortality (13 versus 39 percent) (p < 0.05), as well as portasystemic encephalopathy (8 versus 56 percent) (p < 0.0005). All shunts remained patent postoperatively and no patient had variceal rebleeding during follow-up evaluation averaging 2.2 years. Duplex sonography demonstrated hepatofugal portal flow in all patients in both groups. The results of the current study suggest that partial portal decompression is technically feasible, prevents further variceal hemorrhage and confers significant protection against late mortality and the development of postshunt neuropsychologic dysfunction.
在四年期间，86例患者接受了门腔分流术（PCS）以治疗食管胃静脉曲张出血。28例患者（第1组）接受了急诊全门静脉减压，而58例患者（第2组）接受了择期部分PCS。两组在年龄、性别、分流术前和分流术后的酒精摄入量、手术时以及最新随访评估时的改良Child-Pugh分级方面，差异均无统计学意义。急诊分流术后的早期死亡率高于择期手术（p<0.01）。然而，与全分流相比，部分门静脉减压导致晚期死亡率（13%对39%）（p<0.05）以及门体性脑病（8%对56%）（p<0.0005）的可能性显著降低。所有分流术后均保持通畅，在平均2.2年的随访评估期间，无患者出现静脉曲张再出血。双功超声检查显示两组所有患者均有肝外门静脉血流。本研究结果表明，部分门静脉减压在技术上是可行的，可防止静脉曲张进一步出血，并对晚期死亡率和分流术后神经心理功能障碍的发生具有显著的保护作用。
