Spina G P, Santambrogio R, Opocher E, Cosentino F, Zambelli A, Passoni G R, Cucchiaro G, Macrì M, Morandi E, Bruno S
Department of Surgical Semeiology, San Paolo Institute of Biomedical Science, Milan, Italy.
Ann Surg. 1990 Feb;211(2):178-86. doi: 10.1097/00000658-199002000-00010.
In 1984 we started a prospective controlled trial comparing endoscopic sclerotherapy (ES) with the distal splenorenal shunt (DSRS) in the elective treatment of variceal hemorrhage in cirrhotic patients. The study population included 40 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1988. These patients were drawn from a pool of 173 patients who underwent either elective surgery or endoscopic sclerotherapy during this time. Patients were assigned to one of the two groups according to a random-number table: 20 to DSRS and 20 to ES. During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS. Four ES patients suffered at least one episode of gastrointestinal bleeding: two from varices and two from esophageal ulcerations. Five ES patients developed transitory dysphagia. Long-term follow-up was complete in all patients. Two-year survival rates for shunt (95%) and ES (90%) groups were similar. One DSRS patient rebled from duodenal ulcer, while three ES patients had recurrent bleeding from esophagogastric sources (two from varices and one from hypertensive gastropathy). One DSRS and two ES patients have evolved a mild chronic encephalopathy; four DSRS and two ES patients suffered at least one episode of acute encephalopathy. Two ES patients had esophageal stenoses, which were successfully dilated. Preliminary data from this trial seem to indicate that DSRS, in a subgroup of patients with good liver function and a correct portal-azygos disconnection, more effectively prevents variceal rebleeding than ES. However no significant difference in the survival of the two treatment groups was noted.
1984年，我们开展了一项前瞻性对照试验，比较内镜下硬化疗法（ES）与远端脾肾分流术（DSRS）对肝硬化患者静脉曲张出血的择期治疗效果。研究对象包括1984年10月至1988年3月转诊至我科的40例肝硬化和门静脉高压患者。这些患者来自这一时期接受择期手术或内镜下硬化疗法的173例患者。根据随机数字表将患者分为两组：20例接受DSRS，20例接受ES。术后期间，没有DSRS患者死亡，而1例ES患者死于无法控制的出血。1例DSRS患者尽管DSRS血管造影显示通畅，但仍有轻度复发性静脉曲张出血。4例ES患者至少发生1次胃肠道出血：2例来自静脉曲张，2例来自食管溃疡。5例ES患者出现短暂性吞咽困难。所有患者均完成长期随访。分流术组（95%）和ES组（90%）的两年生存率相似。1例DSRS患者因十二指肠溃疡再次出血，而3例ES患者有食管胃来源的复发性出血（2例来自静脉曲张，1例来自肥厚性胃病）。1例DSRS患者和2例ES患者出现轻度慢性脑病；4例DSRS患者和2例ES患者至少发生1次急性脑病。2例ES患者出现食管狭窄，经成功扩张。该试验的初步数据似乎表明，在肝功能良好且门静脉-奇静脉分流正确的亚组患者中，DSRS比ES更有效地预防静脉曲张再出血。然而，两个治疗组的生存率没有显著差异。
