Department of Surgery, University of California, San Diego, Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8999, USA.
Department of Surgery, Division of Organ Transplantation, University of Rochester Medical Center Rochester, NY, USA.
Am J Surg. 2014 Jan;207(1):46-52. doi: 10.1016/j.amjsurg.2013.06.001. Epub 2013 Sep 24.
In 1994, the authors reported their experience with radical esophagogastrectomy for bleeding esophagogastric varices due to unshuntable extra-hepatic portal hypertension. Since then, the series has expanded from 22 to 44 patients. The aim of this study was to assess the validity of the previous observations and conclusions in the largest series with the longest follow-up.
From 1968 to 2005, 44 patients with unshuntable extra-hepatic portal hypertension were treated by total gastrectomy and resection of the distal two thirds of the esophagus. Before referral, the patients experienced 4 to 24 episodes of variceal bleeding requiring a mean 130 U of blood transfusion, 15 hospital admissions, and 6 previous unsuccessful operations.
Transient postoperative complications occurred in 50% of patients. The survival rate is 100%, with no recurrence of variceal bleeding during 7 to 43 years of follow-up. Liver function and biopsy results have been normal. Quality of life has been excellent or good in 91%. Eighty-six percent have resumed employment or full-time housekeeping.
In unshuntable extra-hepatic portal hypertension, radical esophagogastrectomy is the only consistently effective treatment of variceal hemorrhage. Prompt use of this lifesaving procedure is warranted.
1994 年，作者报道了他们在不可分流的肝外门静脉高压导致的出血性胃食管静脉曲张患者中进行根治性食管胃切除术的经验。从那时起，该系列已从 22 例扩展到 44 例。本研究旨在评估最大系列和最长随访时间的先前观察和结论的有效性。
从 1968 年到 2005 年，44 例不可分流的肝外门静脉高压患者接受了全胃切除术和食管远端三分之二切除术。在转诊前，这些患者经历了 4 到 24 次静脉曲张出血，需要平均输注 130U 的血液，住院 15 次，之前有 6 次手术失败。
50%的患者出现短暂的术后并发症。患者的存活率为 100%，在 7 至 43 年的随访期间没有再次出现静脉曲张出血。肝功能和活检结果均正常。91%的患者生活质量良好或极佳。86%的患者恢复了工作或全职家务劳动。
在不可分流的肝外门静脉高压中，根治性食管胃切除术是治疗静脉曲张出血的唯一有效方法。应及时使用这种救命手术。
