Assadourian R, Abitbol A, Berthet B
Service de Chirurgie Générale et Digestive, Hôtel-Dieu, Marseille.
J Chir (Paris). 1988 Dec;125(12):704-11.
The authors analyse the results of a series of 97 cases of elective porto-caval anastomoses for ruptured oesophageal varices and compare them with those of the literature. Elective porto-caval anastomosis satisfactorily prevents haemorrhagic recurrence (3%) at the cost of an operative mortality of 10% (nil over the last five years). Porto-caval encephalopathy was observed in 36% of cases with an incapacitating form (stage II or III) in 21% of operated patients and always represented the major disadvantage of surgery. However, the place of truncal porto-caval anastomosis is still intact in the prevention of recurrent haemorrhage from ruptured oesophageal varices. Warren's operation, the reference surgical technique, cannot be performed systematically because of technical reasons and/or because of rigorous selection. Endoscopic sclerotherapy represents a fundamental therapeutic procedure during the haemorrhagic period. Permanent haemostasis is more difficult to obtain and requires surgery in about 25% of cases. The mortality and morbidity associated with the endoscopic method are compared with the surgical results in two series of patients belonging to Child's groups A and B.
作者分析了97例因食管静脉曲张破裂而行择期门腔静脉吻合术的病例结果，并与文献报道的结果进行了比较。择期门腔静脉吻合术能有效预防出血复发（3%），但手术死亡率为10%（过去五年为零）。36%的病例出现门腔静脉性脑病，21%的手术患者出现致残性形式（II期或III期），这始终是手术的主要缺点。然而，在预防食管静脉曲张破裂出血复发方面，门腔静脉主干吻合术仍有其地位。由于技术原因和/或严格的选择标准，作为参考手术技术的沃伦手术不能系统地进行。内镜硬化疗法是出血期的基本治疗方法。永久性止血更难实现，约25%的病例需要手术治疗。将内镜治疗方法的死亡率和发病率与两组属于Child A组和B组患者的手术结果进行了比较。
