Bokobza B, Defives T, Duhamel C, Leblanc I, Michot F, Tenière P
Ann Chir. 1989;43(10):799-803.
Between 1 January 1984 and 31 December 1986, 47 patients out of a total of 228 patients admitted to hospital with endoscopy-proven bleeding esophageal varices, underwent an emergency operation. The indications were massive hemorrhage in 29 patients, and rebleeding early after a first serious episode in 18 patients. Four patients underwent early reoperation for recurrent variceal bleeding. Thirty-seven porto-caval shunts, 10 esophageal transections, 3 proximal gastric resections and 1 exploratory laparotomy were performed. The early results were satisfactory in 53.2% of the patients; operative morbidity and mortality were 19.1% and 27.7% respectively. Four patients died from gastric variceal bleeding soon after esophageal transection. Operative mortality was greater when the patient was Child C or operated for massive hemorrhage. Survivors were followed for at least 12 months. Two patients died from shunt occlusion and recurrent variceal bleeding. No severe encephalopathy was reported. Analysis of the results suggest that porto-caval shunt is indicated in Child A or B patients, particularly with recurrent variceal bleeding soon after a first episode controlled medically.
在1984年1月1日至1986年12月31日期间，228例经内镜证实为食管静脉曲张出血而入院的患者中，有47例接受了急诊手术。手术指征为29例大出血患者，以及18例首次严重出血事件后早期再出血患者。4例患者因复发性静脉曲张出血接受了早期再次手术。共进行了37例门腔分流术、10例食管横断术、3例近端胃切除术和1例剖腹探查术。53.2%的患者早期结果满意；手术 morbidity 和死亡率分别为19.1%和27.7%。4例患者在食管横断术后不久死于胃静脉曲张出血。当患者为Child C级或因大出血接受手术时，手术死亡率更高。对幸存者进行了至少12个月的随访。2例患者死于分流闭塞和复发性静脉曲张出血。未报告严重脑病。结果分析表明，门腔分流术适用于Child A级或B级患者，尤其是在首次发作经药物控制后不久出现复发性静脉曲张出血的患者。 （注：原文中“operative morbidity”未明确给出准确中文释义，暂保留英文）
