Kitano S, Ohta M, Ueno K, Hashizume M, Iso Y, Koyanagi N, Sugimachi K
Department of Surgery II, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Nihon Geka Gakkai Zasshi. 1992 Sep;93(9):1156-8.
In Japan, non-shunting procedures and selective shunt such as esophageal transection (ET), and distal splenorenal shunt (DSRS) have been widely performed. A prospective randomized trial was done to assess the effects of EIS and DSRS for treating patients with esophageal varices. Ninety-six Japanese with good liver function (Child A or B) and large esophageal varices were randomly assigned to one of three groups given different treatments; (EIS, n = 32), (ET, n = 32) and (DSRS, n = 32). Five patients (15.6%) of the DSRS group has to be excluded from this study, because of severe chronic pancreatitis. No patient died within 30 days of the treatments. The 5-year cumulative bleeding rates were 0%, 4.3% and 12.1% in the EIS, ET and DSRS groups, respectively, with no statistical significances. In no case in the three groups did the death occur because of variceal bleeding. Nineteen patients died mainly due to the underlying liver disease; 5 in the EIS, 5 in the ET and 9 in the DSRS group. There was no statistically significant difference in the survival rates among the three groups. We conclude that EIS is a satisfactory alternative to ET or DSRS for the management of patients with large esophageal varices.
在日本，非分流手术和选择性分流术，如食管横断术（ET）和远端脾肾分流术（DSRS）已被广泛应用。开展了一项前瞻性随机试验，以评估内镜下硬化剂注射治疗（EIS）和DSRS治疗食管静脉曲张患者的效果。96名肝功能良好（Child A或B级）且患有大型食管静脉曲张的日本患者被随机分配到接受不同治疗的三组之一；（EIS组，n = 32），（ET组，n = 32）和（DSRS组，n = 32）。由于严重慢性胰腺炎，DSRS组有5名患者（15.6%）不得不被排除在本研究之外。治疗后30天内无患者死亡。EIS组、ET组和DSRS组的5年累积出血率分别为0%、4.3%和12.1%，无统计学意义。三组中均无因静脉曲张出血导致死亡的病例。19名患者主要因潜在的肝脏疾病死亡；EIS组5例，ET组5例，DSRS组9例。三组之间的生存率无统计学显著差异。我们得出结论，对于大型食管静脉曲张患者的管理，EIS是ET或DSRS的一种令人满意的替代方法。
