Stipa S, Balducci G, Ziparo V, Stipa F, Lucandri G
1st Department of Surgery, University La Sapienza, V. le del Policlinico, Rome, Italy.
World J Surg. 1994 Mar-Apr;18(2):200-4. doi: 10.1007/BF00294401.
A 20-year experience with treatment of esophageal varices in patients with cirrhosis is reported. Considering that total shunts are well tolerated immediately after operation (hospital mortality rate for all elective procedures being 6.4%), that they offer a good protection against rebleeding (rebleeding variceal rate of 7.6%), and that they offer the same long-term survival as given by other shunts (5- and 10-year survival rates of 57% and 31%, respectively), the authors affirm that these kinds of shunts are still useful in well selected cases. Late follow-up results of a prospective randomized trial of elective mesocaval shunts compared to portacaval shunt have shown no significant differences in operative mortality, rebleeding rates, encephalopathy rates, or survival. Based on this information, the authors currently use portacaval shunt as their operation of choice.
本文报告了对肝硬化患者食管静脉曲张进行治疗的20年经验。考虑到全分流术在术后即刻耐受性良好（所有择期手术的医院死亡率为6.4%），能有效预防再出血（曲张静脉再出血率为7.6%），且长期生存率与其他分流术相同（5年和10年生存率分别为57%和31%），作者认为这类分流术在精心挑选的病例中仍有用处。一项关于择期肠系膜上腔静脉分流术与门腔静脉分流术的前瞻性随机试验的后期随访结果显示，在手术死亡率、再出血率、脑病发生率或生存率方面无显著差异。基于这些信息，作者目前选择门腔静脉分流术作为首选术式。
