Ferrarese S, Nacchiero M, Furino A, Fabiano G
Minerva Chir. 1977 May 15;32(9):523-7.
Massive, active bleeding of the oesophageal varices in cirrhotics requires immediate, comprehensive and continuing appraisal of determining risk parameters (liver function and morphology, hyperdynamic syndrome, renal function, dynamic angiography of the splanchnic circulation). When survival is linked with stopping the haemorrhage, indications must not be looked at restrictively and operation has to be fast. Minor surgical measures aimed at temporary control of the haemorrhage are not satisfactory. Side-to-side portacaval anastomosis is effective in terms of reducing portal pressure and controlling the haemorrhage. Mesenterico-caval shunt with H-dacron graft interposition is sufficient dynamically and has less effect on porto-hepatic flow. Long-term results with this technique requires further study.
肝硬化患者食管静脉曲张出现大量活动性出血时，需要立即、全面且持续地评估以确定风险参数（肝功能和形态、高动力综合征、肾功能、内脏循环动态血管造影）。当生存与止血相关时，适应证的判断不应过于局限，手术必须迅速。旨在临时控制出血的小手术措施并不令人满意。侧侧门腔静脉吻合术在降低门静脉压力和控制出血方面是有效的。采用H型涤纶移植片置入的肠系膜-腔静脉分流术在动态方面是足够的，对门静脉-肝血流的影响较小。该技术的长期效果需要进一步研究。
