Hirner A, Karavias T
Abteilung Allgemein-, Gefäss- und Thoraxchirurgie, Klinikum Steglitz der Freien Universität Berlin.
Zentralbl Chir. 1989;114(3):141-56.
The 5-years-survival rate of patients with liver cirrhosis is limited to about 25%. Still, one of the most important therapeutic procedures in case of bleeding oesophageal and fundic varices is a portasystemic shunt 6 randomized studies have been performed to compare the complete portacaval shunt with the incomplete splenorenal Warren-shunt: The hospital mortality rate (8-10%) and the 5-years-survival rate (43-47%) do not differ; but the rate of postoperative encephalopathy significantly is higher after PCA (40-26%) and the rate of recurrent bleeding significantly is higher after Warren-shunt (13-6%). In case of massively or early recurrent bleeding, we favour an emergency PCA: the mortality rate amounts to 12% in case of the socalled "early operation" (after initially successful balloon tube or sclerotherapy, 52 patients) and 47% in case of "absolute emergency shunt" because of continuing bleeding (119 patients). In the elective situation (58 patients) we favour the Warren-shunt in elderly patients with diabetes mellitus, preexisting encephalopathy or Child-B-classification.
肝硬化患者的5年生存率约为25%。尽管如此，对于食管和胃底静脉曲张出血，最重要的治疗方法之一是门体分流术。已经进行了6项随机研究来比较完全门腔分流术和不完全脾肾Warren分流术：医院死亡率（8-10%）和5年生存率（43-47%）没有差异；但PCA术后脑病发生率显著更高（40-26%），Warren分流术后再出血率显著更高（13-6%）。对于大量出血或早期再出血，我们倾向于急诊PCA：在所谓的“早期手术”（最初成功进行气囊导管或硬化治疗后，52例患者）中死亡率为12%，在因持续出血进行“绝对急诊分流术”（119例患者）中死亡率为47%。在择期情况下（58例患者），对于患有糖尿病、已有脑病或Child-B级分类的老年患者，我们倾向于采用Warren分流术。
