Van Der Staak F H
Tijdschr Kindergeneeskd. 1983 Oct;51(5):163-71.
The optimal treatment of esophageal varices in childhood is an unresolved issue. Despite numerous studies concerning this topic, there seems to be no completely satisfying solution. An open and functioning portasystemic shunt provides a high degree of protection against esophageal variceal bleeding. However, technical obstacles imposed by the size of vessels available for shunting, reluctance to remove the spleen in a child and abnormalities of the portal vein often preclude successful portasystemic shunting in children. Therefore, a two-stage management has been proposed for the treatment of esophageal varices in childhood. In this approach Vossschulte's dissection-ligature has been utilized as a temporizing procedure. This operation has to bridge the time, until a decompressive shunt can be accomplished. Nine children with esophageal varices were treated by the dissection-ligature. There was no operative mortality. One patient succumbed during the follow-up period. One patient had a recurrent bleeding after 2 2/12 yrs, and underwent a shunting procedure at that time. Three patients had an esophageal stricture and swallowing difficulties. They were without complaints after a few dilatations. Data obtained from this study and from the literature indicate, that the dissection-ligature is safe and effective in controlling esophageal variceal bleeding. The dissection-ligature satisfies as temporary measure in the proposed two-stage management. Since many patients did not have any new bleeding-episodes and did not need any further surgery as well, it may be suggested that the dissection-ligature is not only suitable for temporary treatment, but also for permanent treatment. The dissection-ligature of Vossschulte should be kept in mind, if one is forced to consider a 'direct operation' of esophageal varices.
儿童食管静脉曲张的最佳治疗方法仍是一个未解决的问题。尽管针对该主题进行了大量研究，但似乎仍没有完全令人满意的解决方案。开放且功能正常的门体分流术可提供高度保护，防止食管静脉曲张出血。然而，可供分流的血管尺寸所带来的技术障碍、不愿在儿童身上切除脾脏以及门静脉异常等因素，常常使儿童难以成功进行门体分流术。因此，有人提出采用两阶段管理方法来治疗儿童食管静脉曲张。在这种方法中，Vossschulte的解剖结扎术被用作一种临时措施。该手术必须过渡到能够完成减压分流术的时间。9名患有食管静脉曲张的儿童接受了解剖结扎术治疗。手术无死亡率。1名患者在随访期间死亡。1名患者在2又2/12年时出现复发性出血，当时接受了分流手术。3名患者出现食管狭窄和吞咽困难。经过几次扩张后，他们没有了不适症状。从本研究和文献中获得的数据表明，解剖结扎术在控制食管静脉曲张出血方面是安全有效的。在提议的两阶段管理中，解剖结扎术作为临时措施是令人满意的。由于许多患者没有出现任何新的出血事件，也不需要进一步手术，因此可以认为解剖结扎术不仅适用于临时治疗，也适用于永久治疗。如果不得不考虑对食管静脉曲张进行“直接手术”，应牢记Vossschulte的解剖结扎术。
