Sanjo K, Idezuki Y, Hirata M, Kawasaki S, Ohashi K, Koyama H, Kokudo N
Second Department of Surgery, University of Tokyo, Faculty of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1538-40.
Non-shunting operations were performed in 522 patients with esophagogastric varices in our department from January 1964 to March 1989. Transthoracoabdominal esophageal transection was performed in 287 patients (devascularization of the distal esophagus and the proximal half of the stomach and transection of the esophagus). Transthoracic esophageal transection was performed in 125 patients (31 Walker's transection, 94 esophageal transection with devascularization of distal esophagus). Transabdominal esophageal transection was performed in 49 patients. Hassab's operation was performed in 49 patients and three patients were treated with other direct operations (proximal gastrectomy, etc.) Overall mortality of non-shunting operation was 5.0%. The five year survival of idiopathic portal hypertension was 77.6%, extrahepatic portal obstruction was 90.7% and liver cirrhosis was 63.1%. Five year survival of Child's grade A was 79.8%, Child's grade B was 72.9% and Child's grade C was 38.6%. Operation on Child's C patients should be avoided since the results in these patients have been unsatisfactory. Our overall results with esophageal transection over the last two decades are satisfactory.
1964年1月至1989年3月，我科对522例食管胃静脉曲张患者进行了非分流手术。287例患者行胸腹联合食管横断术（远端食管和胃近端一半去血管化及食管横断）。125例患者行开胸食管横断术（31例Walker横断术，94例远端食管去血管化的食管横断术）。49例患者行经腹食管横断术。49例患者行Hassab手术，3例患者接受其他直接手术（近端胃切除术等）。非分流手术的总死亡率为5.0%。特发性门静脉高压症患者的5年生存率为77.6%，肝外门静脉阻塞患者为90.7%，肝硬化患者为63.1%。Child A级患者的5年生存率为79.8%，Child B级为72.9%，Child C级为38.6%。由于Child C级患者的手术效果不理想，应避免对其进行手术。过去二十年来，我们食管横断术的总体效果令人满意。
