Lee Joo-Ho, Han Ho-Seong, Kim Hyun-Ah, Koo Min-Young
Department of Surgery, Ewha Womans University, School of Medicine, 911-1, Mok-6-Dong, Yangcheon-Gu, 158-710, Seoul, Korea.
World J Surg. 2009 Oct;33(10):2144-9. doi: 10.1007/s00268-009-0153-9.
Gastric variceal bleeding is life-threatening, and occasionally it requires operative intervention, but its treatment is controversial. Based on our experience, we considered that fundectomy and periesophagogastric devascularization (FPD) offers an effective treatment method. Accordingly, this study was undertaken to document postoperative and long-term follow-up results, such as, gastric variceal bleeding recurrence and patient survival.
A retrospective analysis was conducted on 41 patients with gastric fundal variceal bleeding who underwent FPD between August 1994 and May 2005. The evaluation included clinical characteristics, operative morbidity, mortality, and long-term follow up results.
Operative morbidity and mortality rates were 26.8% and 17.1%, respectively. Child-Pugh classification, number of previous variceal bleeding episodes, success of preoperative intervention, and ongoing active bleeding during surgery were all factors found to have significant effects on postoperative mortality. No recurrent bleeding from gastric varices was encountered over a median follow-up period of 52.1 months. The cumulative 5-year survival rate was 62.0%, and the major causes of death were hepatocellular carcinoma (HCC) and hepatic failure.
The operative procedure used in this study resulted in a low rate of recurrent bleeding and good long-term survival. This analysis of results suggests that fundectomy and periesophagogastric devascularization is an effective therapeutic intervention in patients with fundal variceal bleeding.
胃静脉曲张出血危及生命，偶尔需要手术干预，但其治疗存在争议。根据我们的经验，我们认为胃底切除术和食管胃周围去血管化术（FPD）提供了一种有效的治疗方法。因此，本研究旨在记录术后及长期随访结果，如胃静脉曲张出血复发情况和患者生存率。
对1994年8月至2005年5月期间接受FPD的41例胃底静脉曲张出血患者进行回顾性分析。评估内容包括临床特征、手术发病率、死亡率及长期随访结果。
手术发病率和死亡率分别为26.8%和17.1%。Child-Pugh分级、既往静脉曲张出血发作次数、术前干预成功率及手术期间持续活动性出血均被发现对术后死亡率有显著影响。在中位随访期52.1个月内未出现胃静脉曲张复发出血。5年累积生存率为62.0%，主要死亡原因是肝细胞癌（HCC）和肝衰竭。
本研究采用的手术方法导致复发出血率低且长期生存率良好。结果分析表明，胃底切除术和食管胃周围去血管化术是治疗胃底静脉曲张出血患者的有效治疗干预措施。
