Hirata M, Kawasaki S, Sanjo K, Idezuki Y
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Br J Surg. 1991 Nov;78(11):1352-4. doi: 10.1002/bjs.1800781127.
Thirty-six patients with oesophageal varices underwent a non-shunting operation including oesophageal transection. Of these, 16 had an emergency or elective operation (bleeders) and the remaining 20 had prophylactic surgery (non-bleeders). A comparative study was performed between the bleeders and non-bleeders in terms of preoperative endoscopic findings and histopathology of the oesophagus. The severity of red colour sign showed no significant difference between the two groups. The venous dilatation in each of the three layers of the oesophageal mucosa was demonstrated histologically to be of the same degree in bleeders and non-bleeders. In addition, the hepatic venous pressure gradient in cirrhotic patients did not differ between the two groups; for bleeders this was a mean(s.d.) of 15.2(6.1) mmHg and for non-bleeders 14.4(2.9) mmHg. We were unable to find any factors differentiating bleeders from non-bleeders, although these results do not justify prophylactic surgery for oesophageal varices.
三十六例食管静脉曲张患者接受了包括食管横断术在内的非分流手术。其中，16例接受了急诊或择期手术（出血者），其余20例接受了预防性手术（非出血者）。对出血者和非出血者在术前内镜检查结果和食管组织病理学方面进行了比较研究。红色征的严重程度在两组之间无显著差异。组织学显示，食管黏膜三层中每层的静脉扩张在出血者和非出血者中程度相同。此外，肝硬化患者的肝静脉压力梯度在两组之间无差异；出血者的平均（标准差）为15.2（6.1）mmHg，非出血者为14.4（2.9）mmHg。我们未能找到任何区分出血者和非出血者的因素，尽管这些结果并不支持对食管静脉曲张进行预防性手术。
