Nagasue N, Kohno H, Ogawa Y, Yukaya H, Tamada R, Sasaki Y, Chang Y C, Nakamura T
World J Surg. 1989 Jan-Feb;13(1):92-9; discussion 99. doi: 10.1007/BF01671163.
From June, 1969 to February, 1987, distal splenorenal shunt was carried out on 78 patients with esophagogastric varices. The operations were urgent in 9, elective in 40, and prophylactic in 29 patients. There were 52 males and 26 females. Age ranged from 16 to 76 years with an average of 53 years. Thirty-seven patients were alcoholics. Hepatitis B surface antigen was positive in only 15.5%. The causes of portal hypertension were cirrhosis of the liver in 67, chronic hepatitis in 5, idiopathic portal hypertension in 4, primary biliary cirrhosis in 1, and fatty liver in 1 patient. Fifty-two patients were in Child's class A, 18 in class B, and 8 in class C. Emergency shunts were performed only when conservative therapy had failed to stop variceal bleeding. Prophylactic operations were done in patients having Child's class A or class B liver disease and risky varices, in varices larger than 5 mm in diameter and/or varices with red color signs such as cherry red spots. Forty-two patients underwent the original Warren shunt, but the remaining 36 had modified distal splenorenal shunt with expanded polytetrafluoroethylene interposition. The operative mortality rates were 11.1% in the emergency group, 2.5% in the elective group, and 3.4% in the prophylactic group. The overall operative and hospital death rates were 3.8% and 7.7%, respectively. The patency rate was 94.1% and the incidence of rebleeding from esophageal varices was 3.8%. Hepatic encephalopathy, although mild to moderate in degree, was observed in 14.7% of 75 patients excluding 3 operative deaths.(ABSTRACT TRUNCATED AT 250 WORDS)
1969年6月至1987年2月，对78例食管胃静脉曲张患者施行了远端脾肾分流术。其中9例为急诊手术，40例为择期手术，29例为预防性手术。患者中男性52例，女性26例。年龄在16至76岁之间，平均53岁。37例患者为酗酒者。乙肝表面抗原阳性率仅为15.5%。门静脉高压的病因包括：67例为肝硬化，5例为慢性肝炎，4例为特发性门静脉高压，1例为原发性胆汁性肝硬化，1例为脂肪肝。52例患者为Child A级，18例为B级，8例为C级。仅在保守治疗未能止住曲张静脉出血时才进行急诊分流术。对患有Child A级或B级肝病且有高危静脉曲张、直径大于5 mm的静脉曲张和/或有红色征（如樱桃红点）的静脉曲张患者进行预防性手术。42例患者接受了最初的Warren分流术，但其余36例采用了带聚四氟乙烯人工血管植入的改良远端脾肾分流术。急诊组手术死亡率为11.1%，择期组为2.5%，预防性组为3.4%。总体手术死亡率和住院死亡率分别为3.8%和7.7%。分流血管通畅率为94.1%，食管静脉曲张再出血发生率为3.8%。在75例（不包括3例手术死亡患者）患者中，14.7%出现了程度为轻至中度的肝性脑病。（摘要截选至250词）
