Hunt P S, Ferraro V, Parkin G
Aust N Z J Surg. 1985 Aug;55(4):359-64. doi: 10.1111/j.1445-2197.1985.tb00900.x.
In a prospective study from 1972 to 1982, 38 patients with bleeding oesophageal varices and relatively good liver function were treated by semi-elective or emergent shunt 2-4 weeks after admission. There were no deaths within 3 months of surgery. This constituted 30% of the total 125 patients admitted with bleeding varices during that period. No referred case for treatment of portal hypertension was included in this study. The procedures performed were end-to-side portacaval shunt in 30 cases, lieno renal shunt in seven cases and interposition mesenterico-caval shunt in one case. All patients were admitted to a special unit with a two stage policy of management. Immediate endoscopic diagnosis and balloon tamponade in those with continued bleeding was followed by shunt in selected cases. Follow-up of the 38 patients showed a cumulative survival at 1 year of 89%, at 3 years of 75% and 5 years of 65%. In four cases (13%) a clinical diagnosis of portal systemic encephalopathy was made, all were controlled by medical management. In four of ten follow-up deaths, liver failure was the cause, in none of these cases was encephalopathy a problem. It is concluded that with a policy of early diagnosis and control of haemorrhage, 30% of a typical series of prospectively studied patients admitted with bleeding varices can be treated without mortality by definitive surgery. There was low incidence of encephalopathy and no cases of incapacitating mental confusion. Centralization of treatment and prospective study is essential for the implementation of such a policy of management.
在一项1972年至1982年的前瞻性研究中，38例食管静脉曲张出血且肝功能相对较好的患者在入院后2 - 4周接受了半择期或急诊分流手术。术后3个月内无死亡病例。这占该时期因静脉曲张出血入院的125例患者总数的30%。本研究未纳入因门静脉高压转诊治疗的病例。所施行的手术包括30例端侧门腔分流术、7例脾肾分流术和1例肠系膜上静脉 - 下腔静脉搭桥分流术。所有患者均入住一个特殊病房，采用两阶段治疗策略。对于持续出血的患者，先进行即刻内镜诊断和气囊压迫止血，然后对部分病例进行分流手术。对这38例患者的随访显示，1年累计生存率为89%，3年为75%，5年为65%。有4例（13%）临床诊断为门体性脑病，均通过药物治疗得到控制。在10例随访死亡病例中，有4例死于肝功能衰竭，这些病例均未出现脑病问题。结论是，通过早期诊断和控制出血的策略，在一系列前瞻性研究的因静脉曲张出血入院的典型患者中，30%的患者可通过确定性手术治疗且无死亡风险。脑病发生率低，无导致精神错乱失能的病例。集中治疗和前瞻性研究对于实施这样的治疗策略至关重要。
