Gigot J F, Otte J B, Lambotte L, Reynaert M, Geubel A, Carlier M, de Hemptinne B, Claeys N, Kestens P J
Cliniques Universitaires St Luc, Université Catholique de Louvain.
Acta Gastroenterol Belg. 1990 Mar-Apr;53(2):237-47.
In order to evaluate the benefit of arterialization of the portal vein in conjunction with a therapeutic end-to-side porto-caval shunt, we started in December 1979 a prospective randomized study, comparing these two techniques in Child class A and B cirrhotic patients with a hepatopetal portal flow of at least 100 ml per min. Sixty-four patients have been included in the study: 33 underwent a porto-caval shunt (NART) and 31 were arterialized (ART). The two groups of patients were similar as regards clinical and hemodynamic parameters. The operative mortality was lower after arterialization, considering the whole group (ART: 6.5%, NART: 12%) and high risk patients (Child class B: ART: 0%, NART: 22%--emergency operation: ART: 0%, NART: 17%) but the differences were not statistically significant. Postoperative ascites was more frequent in arterialized patients (ART: 45%, NART: 18%; p = 0.02), with an increased need for reoperation (ART: 26%, NART: 6%; p less than 0.05). The mean follow-up period is 56.9 +/- 28.1 months (SD) for the 58 surviving patients. The five-year actuarial survival rate is 68% for ART patients and 60.6% for NART patients (NS). In child B patients the five-year actuarial survival rate is 75% in ART patients and 22% in NART patients (p less than 0.05). Actuarial estimation of arterialization patency--proved by angioscan--is 38% at five years. There were no significant differences in the incidences of postoperative and long-term encephalopathy and liver function between the two groups. In conclusion, arterialization of the portal vein in conjunction with a therapeutic end-to-side porto-caval shunt improved survival in high risk patients (Child class B), did not increase operative mortality in Child A and B patients, was followed by a higher incidence of postoperative ascites and did not decrease the incidence of long-term encephalopathy.
为了评估门静脉动脉化联合治疗性端侧门腔分流术的益处，我们于1979年12月启动了一项前瞻性随机研究，在Child A级和B级、肝内向门静脉血流至少为每分钟100毫升的肝硬化患者中比较这两种技术。64例患者纳入研究：33例行门腔分流术（NART组），31例行门静脉动脉化术（ART组）。两组患者在临床和血流动力学参数方面相似。考虑整个研究组（ART组：6.5%，NART组：12%）以及高危患者（Child B级：ART组：0%，NART组：22%——急诊手术：ART组：0%，NART组：17%），动脉化术后手术死亡率较低，但差异无统计学意义。动脉化患者术后腹水更常见（ART组：45%，NART组：18%；p = 0.02），再次手术需求增加（ART组：26%，NART组：6%；p<0.05）。58例存活患者的平均随访期为56.9±28.1个月（标准差）。ART组患者的五年精算生存率为68%，NART组患者为60.6%（无统计学差异）。Child B级患者中，ART组患者的五年精算生存率为75%，NART组患者为22%（p<0.05）。经血管扫描证实，动脉化通畅的五年精算估计率为38%。两组术后和长期脑病发生率及肝功能无显著差异。总之，门静脉动脉化联合治疗性端侧门腔分流术提高了高危患者（Child B级）的生存率，未增加Child A级和B级患者的手术死亡率，术后腹水发生率较高，且未降低长期脑病发生率。
