Harada A, Nonami T, Nakao A, Kishimoto W, Murakami H, Takagi H
Department of Surgery II, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1992 Sep;93(9):1169-72.
Between 1973 and 1991, 193 patients underwent terminal esophagoproximal gastrectomy (TEPG) for esophageal varices. One hundred and sixty patients (84%) were cirrhotics. Ten patients (5.2%) were died within hospital stay. In 116 elective patients who had been free from hepatocellular carcinoma during therapeutic courses, the 5- and 10-year survival rates were 77% and 62% in Child A, and 62% and 38% in Child B, respectively. There was a significant difference between the two groups (p < 0.05). Postoperative rebleeding from esophageal varices was infrequent within 5 years but increased after 5 years especially in Child B and Child C. For patients with these recurrent varices, endoscopic injection sclerotherapy was very effective and improved the prognosis. The survival rate of patients with extremely decreased platelet counts was not different from that of patients without. There were no other severe complications after TEPG. We conclude that TEPG would be indicated firstly for elective or prophylactic cases unless they have severe hepatic damage.
1973年至1991年间，193例患者因食管静脉曲张接受了食管近端胃切除术（TEPG）。160例（84%）为肝硬化患者。10例（5.2%）患者在住院期间死亡。在治疗过程中未发生肝细胞癌的116例择期手术患者中，Child A级患者的5年和10年生存率分别为77%和62%，Child B级患者分别为62%和38%。两组之间存在显著差异（p<0.05）。食管静脉曲张术后5年内再出血不常见，但5年后增加，尤其是Child B级和Child C级患者。对于这些复发性静脉曲张患者，内镜注射硬化疗法非常有效并改善了预后。血小板计数极低的患者的生存率与未出现这种情况的患者没有差异。TEPG术后没有其他严重并发症。我们得出结论，TEPG首先适用于择期或预防性病例，除非他们有严重的肝损伤。
