Paquet K J, Mercado M A, Koussouris P, Kalk J F, Siemens F, Cuan-Orozco F
Department of Surgery and Medicine, Heinz-Kalk Hospital, West Germany.
Ann Surg. 1989 Aug;210(2):184-9. doi: 10.1097/00000658-198908000-00008.
In a 5-year period 299 patients were admitted to the Heinz-Kalk Hospital with bleeding esophageal varices. Patients with acute bleeding were treated with endoscopic sclerotherapy. Sessions were performed as many times as needed for each individual case. One hundred seventy-eight patients in Child-Pugh class C were excluded from surgical treatment; the remaining 121 patients (Child AB) were selected using the following criteria: liver volume (ultrasound) between 1000 to 2500 ml, portal perfusion (sequential scintigraphy) more than 30%, no activity or progression of liver disease proved by biopsy, no stenosis of the hepatic arteries, and suitable anatomy to perform the Warren shunt. Only 32 patients fulfilled these criteria. In seven of these cases the shunt was technically impossible to perform. Operative mortality rate was 8% and the late mortality rate was 12%. No history of rebleeding, encephalopathy, and/or shunt thrombosis was recorded. Five-year survival rate, according to the method of Kaplan-Meier was 75%. We conclude that the Warren shunt is the treatment of choice for elective management of bleeding esophageal varices. The postoperative results can be improved with strict selection using the above criteria. The preoperative use of sclerotherapy has a positive influence. Prophylactic management to prevent encephalopathy is also recommended.
在5年期间，299例食管静脉曲张破裂出血患者入住海因茨 - 卡尔克医院。急性出血患者接受内镜硬化治疗。根据每个病例的需要进行多次治疗。178例Child-Pugh C级患者被排除在手术治疗之外；其余121例患者（Child AB级）根据以下标准进行选择：肝脏体积（超声检查）在1000至2500毫升之间，门静脉灌注（序贯闪烁扫描）超过30%，活检证实无肝病活动或进展，肝动脉无狭窄，且具备进行沃伦分流术的合适解剖结构。只有32例患者符合这些标准。其中7例因技术原因无法进行分流手术。手术死亡率为8%，晚期死亡率为12%。未记录到再出血、肝性脑病和/或分流血栓形成的病史。根据Kaplan-Meier方法计算，5年生存率为75%。我们得出结论，沃伦分流术是择期治疗食管静脉曲张破裂出血的首选方法。通过严格按照上述标准进行选择可以改善术后结果。术前使用硬化治疗有积极影响。还建议采取预防性措施以预防肝性脑病。
