Gibson P R, McInnes I E, Rosengarten D S, Jakobovits A W, Coventry D A, Dudley F J
Aust N Z J Surg. 1981 Aug;51(4):336-40. doi: 10.1111/j.1445-2197.1981.tb04959.x.
During the past 51/2 years, thirty consecutive and unselected patients who bled from oesophageal varices underwent distal lienorenal shunt surgery. Eight deaths occurred in the immediate postoperative period. Three of nine emergency patients died because of continued bleeding and, of the five elective patients who died, four were largely the result of technical problems encountered at surgery. In the immediate postoperative period variceal bleeding recurred in five of eight emergency patients despite shunt patency. This did not occur in the elective group. Shunt blockage was relatively common compared to that following conventional porta-systemic shunt surgery; being documented in five of the 24 patients in whom patency was assessed. No clinical, biochemical or histological criteria were identified as predictors of outcome. In particular, the presence of preoperative ascites gave no indication of postoperative problems. However, if ascites developed in the immediate postoperative period, it was a major management problem in 50% of patients. In conclusion, the distal lienorenal shunt has a high perioperative mortality, is commonly complicated by shunt thrombosis and, in the emergency situation, often fails to control bleeding. The technical difficulties encountered at surgery appear largely responsible for the early morbidity and mortality.
在过去的5年半时间里，连续30例未经挑选的食管静脉曲张出血患者接受了远端脾肾分流手术。术后近期有8例死亡。9例急诊患者中有3例因持续出血死亡，5例择期手术患者死亡，其中4例主要是手术中遇到的技术问题所致。尽管分流血管通畅，但8例急诊患者中有5例在术后近期再次发生静脉曲张出血，择期手术组未出现这种情况。与传统的门体分流手术相比，分流血管堵塞相对常见；在评估血管通畅情况的24例患者中有5例记录到血管堵塞。未发现临床、生化或组织学标准可作为预后的预测指标。特别是术前腹水的存在并不能提示术后问题。然而，如果术后近期出现腹水，50%的患者会出现严重的处理问题。总之，远端脾肾分流手术围手术期死亡率高，常并发分流血管血栓形成，在急诊情况下常无法控制出血。手术中遇到的技术困难似乎是导致早期发病和死亡的主要原因。
