Lebezev V M, Eramishantsev A K, Grigorian R S
Khirurgiia (Mosk). 2007(10):15-8.
Results of portocaval bypass (1st group), suture ligation of gastric and esophageal varicose veins (2nd group), and combined operations (3rd group) performed in early postoperative period at 759 patients with liver cirrhosis and extrahepatic portal hypertension are analyzed. Long-term results were studied at 549 patients. Early recurrence of bleeding was occurred at 41 (12.9%) patients of 1st group, at 17 (8.5%) of 2nd, and at 2 (4%) patients of 3rd group. Lethality due to bleeding recurrence at 1st group was 5.1% among the patients with liver cirrhosis and 1.9% among ones with extrahepatic portal hypertension. Recurrence of bleeding at 2nd group was seen at 52.8% patients with liver cirrhosis, and at 36.4% - with extrahepatic portal hypertension. Lethality due to bleeding recurrence in this group was 7%. The best results were achieved in 3rd group: the recurrence of bleeding was diagnosed at 2 (7.7%) cases, there was 1 lethal outcome. It is concluded that combined surgical procedures at the patients with portal hypertension permit to reduce the rate of early recurrences of bleeding in 2.5 times. It allow to perform widely the partial portocaval anastomoses at the patients with liver cirrhosis and the bypass procedures at extrahepatic portal hypertension.
分析了759例肝硬化合并肝外门静脉高压患者在术后早期进行门腔分流术（第一组）、胃食管静脉曲张缝扎术（第二组）和联合手术（第三组）的结果。对549例患者进行了长期结果研究。第一组41例（12.9%）患者出现早期出血复发，第二组17例（8.5%），第三组2例（4%）。第一组因出血复发导致的肝硬化患者死亡率为5.1%，肝外门静脉高压患者死亡率为1.9%。第二组肝硬化患者出血复发率为52.8%，肝外门静脉高压患者为36.4%。该组因出血复发导致的死亡率为7%。第三组取得了最佳结果：2例（7.7%）诊断为出血复发，有1例死亡。结论是，门静脉高压患者的联合手术可使早期出血复发率降低2.5倍。它允许对肝硬化患者广泛进行部分门腔吻合术，并对肝外门静脉高压患者进行分流手术。
