Langer B, Patel S C, Stone R M, Colapinto R F, Phillips M J, Fisher M M
Can Med Assoc J. 1978 Feb 18;118(4):369-72.
The results of surgical treatment of bleeding esophageal varices over an 8-year period in 155 patients are reviewed. Primary treatment of bleeding was conservative, with intravenous administration of vasopressin and balloon tamponade. Emergency operations were carried out after 48 hours in persons with persistent bleeding who were surgical candidates. Operative mortality was higher in this group (40%) than in those undergoing elective or urgent operations (each 10%). Postoperative encephalopathy occurred in 35% of patients and was correlated closely to late death after establishment of a shunt. The mesocaval shunt is no better than the portacaval but appears to be a good alternative in an emergency. In a controlled trial the distal splenorenal shunt was found to be associated with a lower rate of postoperative encephalopathy than the portacaval shunt, but thus far the long-term survival rates have not differed.
回顾了155例患者在8年期间食管静脉曲张出血的外科治疗结果。出血的初始治疗为保守治疗，采用静脉注射血管加压素和气囊压迫。对于持续出血且适合手术的患者，48小时后进行急诊手术。该组患者的手术死亡率（40%）高于接受择期或急诊手术的患者（均为10%）。35%的患者术后发生脑病，且与分流术后的晚期死亡密切相关。肠系膜上腔静脉分流术并不优于门腔静脉分流术，但在紧急情况下似乎是一个不错的选择。在一项对照试验中，发现远端脾肾分流术与门腔静脉分流术相比，术后脑病发生率较低，但迄今为止，长期生存率并无差异。
