Rikkers L F, Jin G
Department of Surgery, University of Nebraska Medical Center, Omaha, USA.
Arch Surg. 1995 May;130(5):472-7. doi: 10.1001/archsurg.1995.01430050022002.
To evaluate the results of selective and nonselective emergency portosystemic shunts in patients with acute variceal hemorrhage.
Retrospective review.
University medical center and Veterans Affairs medical center.
Forty-two consecutive patients who underwent emergency portosystemic shunts from 1978 through 1994. All patients had chronic liver disease (29 [69%] had alcoholic cirrhosis) and half had Child's class C disease. Sixteen patients were actively bleeding at the time of surgery, and 26 had bled within 48 hours. Twenty-two patients underwent a nonselective shunt and 20 underwent a distal splenorenal shunt. The percentages of patients with Child's class C disease and with active bleeding at the time of surgery were significantly higher in the nonselective shunt group.
Operative mortality; early postoperative rebleeding, shunt patency, encephalopathy, and ascites; and long-term survival.
Operative mortality rates were higher in patients with Child's class C disease (43% [9/21]) than in patients with Child's class A or B disease (9% [2/21]) and were higher in patients with active bleeding (all of whom underwent nonselective shunt) (44% [7/16]) than in patients who underwent distal splenorenal shunt (10% [2/20]). All shunts were patent after surgery, and no patient had rebleeding during the early postoperative interval. Early postoperative ascites and encephalopathy rates were similar after nonselective shunt and distal splenorenal shunt. Long-term survival was superior in the lower-risk distal splenorenal shunt group.
Even though more effective nonoperative treatments are now available, emergency portosystemic shunt remains an important option for selected patients with acute variceal hemorrhage. When bleeding can be temporarily controlled by nonoperative means, distal splenorenal shunt is an effective and safe emergency procedure. The mortality rate remains high for patients with Child's class C disease undergoing protal decompression.
评估选择性和非选择性急诊门体分流术治疗急性静脉曲张出血患者的效果。
回顾性研究。
大学医学中心和退伍军人事务医疗中心。
1978年至1994年间连续42例行急诊门体分流术的患者。所有患者均患有慢性肝病（29例[69%]为酒精性肝硬化），半数为Child C级疾病。16例患者在手术时正在出血，26例在48小时内出血。22例患者接受了非选择性分流术，20例接受了远端脾肾分流术。非选择性分流术组中Child C级疾病患者和手术时正在出血的患者比例明显更高。
手术死亡率；术后早期再出血、分流通畅情况、肝性脑病和腹水；以及长期生存率。
Child C级疾病患者的手术死亡率（43%[9/21]）高于Child A级或B级疾病患者（9%[2/21]），正在出血的患者（均接受非选择性分流术）的手术死亡率（44%[7/16]）高于接受远端脾肾分流术的患者（10%[2/20]）。术后所有分流均通畅，术后早期无患者再出血。非选择性分流术和远端脾肾分流术后早期腹水和肝性脑病发生率相似。低风险的远端脾肾分流术组长期生存率更高。
尽管现在有了更有效的非手术治疗方法，但急诊门体分流术仍是部分急性静脉曲张出血患者的重要选择。当出血可通过非手术方法暂时控制时，远端脾肾分流术是一种有效且安全的急诊手术。接受门静脉减压的Child C级疾病患者死亡率仍然很高。
