Cheema M A, Shehri M Y
Department of Surgery, King Saud University, College of Medicine, Abha, Saudi Arabia.
J Pak Med Assoc. 1995 Jan;45(1):6-9.
A total of 72 patients were operated for bleeding esophageal varices over five years. Cause of portal hypertension was cirrhosis in 33, Schistosomal fibrosis in 23 and a combination of the two diseases in 3 cases. Biopsy was not available in 13 patients. Fifty-eight patients were child grade A and B, while 14 patients were grade C. Overall, there were 16 hospital deaths (22.2%) and 28 patients had complications (38.8%). Specifically, Hassab's operation was done in 40 patients with 12.5% mortality and 11.7% incidence of rebleeding. Hassab's operation plus esophageal transection in 13 patients was associated with 46.1% mortality and no incidence of rebleeding. Warren's splenorenal shunt, done in 11 patients, was accompanied by 1 (9%) death and no incidence of rebleeding. Mortality rate increased significantly when esophageal transection was added to Hassab's operation. It is concluded that for low risk patients being operated electively, Warren's shunt is an acceptable alternative to Hassab's operation which is better suited to emergency situations. Esophageal transection should not be added to Hassab's operation because this increases the mortality.
在五年期间，共有72例患者因食管静脉曲张破裂出血接受手术治疗。门静脉高压的病因中，33例为肝硬化，23例为血吸虫性肝纤维化，3例为两种疾病并存。13例患者未进行活检。58例患者为Child A级和B级，14例为C级。总体而言，有16例患者在医院死亡（22.2%），28例患者出现并发症（38.8%）。具体来说，40例患者接受了哈萨布手术，死亡率为12.5%，再出血发生率为11.7%。13例患者接受了哈萨布手术加食管横断术，死亡率为46.1%，无再出血发生。11例患者接受了沃伦脾肾分流术，有1例（9%）死亡，无再出血发生。在哈萨布手术基础上加做食管横断术时，死亡率显著增加。结论是，对于择期手术的低风险患者，沃伦分流术是哈萨布手术的一种可接受的替代方法，哈萨布手术更适合紧急情况。不应在哈萨布手术上加做食管横断术，因为这会增加死亡率。
