改良 Sugiura 手术治疗静脉曲张出血的长期疗效：在治疗食管静脉曲张出血方面经得起时间的考验。
Long-term results with the modified Sugiura procedure for the management of variceal bleeding: standing the test of time in the treatment of bleeding esophageal varices.
机构信息
2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece.
出版信息
World J Surg. 2012 Mar;36(3):659-66. doi: 10.1007/s00268-011-1418-7.
BACKGROUND
The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. In the present study we retrospectively analyzed the results of the modified Sugiura procedure, performed as emergency and semi-elective treatment in the patient with bleeding esophageal varices.
METHODS
Ninety patients with cirrhosis and portal hypertension were managed in our department for variceal esophageal bleeding between January 1985 and December 1992. The modified Sugiura procedure was performed in 46 patients on an emergency (25 patients) or semi-elective (21 patients) basis. Liver cirrhosis stage according to Child classification was A in 4 patients, B in 16 patients, and C in 26 patients.
RESULTS
Acute bleeding was controlled in all patients. Postoperative mortality was 23.9% (11 of 46 patients). The mortality rate was 34.6% in Child class C patients (9 of 26 patients), and 12.5% in Child class B patients (2 of 16 patients). Twenty-four patients had long-term follow-up extending from 14 months to 22 years (mean 83.1 months). Ten of 24 patients (41.6%) did not develop rebleeding for 5-22 years (mean 10.3 years). Overall 5-year survival in these 24 patients was 62.5%.
CONCLUSIONS
The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available.
背景
自从内镜硬化疗法、经颈静脉肝内门体分流术（TIPS）和肝移植在临床应用以来，治疗肝硬化患者食管静脉曲张出血的手术方法已经减少。然而，当急性硬化疗法失败，并且没有其他治疗方法时，急诊手术可能是救命的。在本研究中，我们回顾性分析了改良 Sugiura 手术在食管静脉曲张出血患者中的治疗效果，该手术作为紧急和半选择性治疗方法。
方法
1985 年 1 月至 1992 年 12 月，我们科室共收治了 90 例肝硬化门静脉高压症患者，这些患者因食管静脉曲张出血接受了治疗。46 例患者因紧急情况（25 例）或半选择性（21 例）接受了改良 Sugiura 手术。根据 Child 分类，肝硬化分期为 A 期 4 例，B 期 16 例，C 期 26 例。
结果
所有患者的急性出血均得到控制。术后死亡率为 23.9%（46 例患者中的 11 例）。Child 分类 C 期患者的死亡率为 34.6%（26 例患者中的 9 例），Child 分类 B 期患者的死亡率为 12.5%（16 例患者中的 2 例）。24 例患者获得了 14 个月至 22 年（平均 83.1 个月）的长期随访。24 例患者中有 10 例（41.6%）在 5-22 年内未再出血（平均 10.3 年）。这些 24 例患者的总体 5 年生存率为 62.5%。
结论
当替代治疗失败或不适用时，改良 Sugiura 手术仍然是治疗食管静脉曲张出血患者的有效抢救治疗方法。此外，对于分流手术解剖结构不合适或在非专门中心没有分流手术外科专业知识的患者，该手术也是一种救命手术。
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