Collins J C, Rypins E B, Sarfeh I J
Surgical Service (112), Veterans Affairs Medical Center, Long Beach, California 90822.
World J Surg. 1994 Mar-Apr;18(2):211-5. doi: 10.1007/BF00294403.
Over the past decade, we have developed and refined a method for partial portosystemic shunting for the control of bleeding esophageal varices in alcoholic cirrhotic patients. The narrow-diameter interposition portacaval H-graft using 8 mm polytetrafluoroethylene has been performed in 32 patients at our institution with low operative mortality (6.3%) and nearly complete cessation of variceal bleeding (96.7%) over a mean follow-up period of 43 months. In comparison with total shunts, diminished rates of postshunt encephalopathy (13% versus 40%) have been observed. Prograde portal blood flow has been preserved in 90% of 30 patients studied by perioperative portography. Shunt patency with continued prograde flow has been demonstrated at up to 9 years of follow-up. Investigators at three other centers have studied partial shunting using substantially similar techniques, with similar findings. Based on these results, we conclude that narrow-diameter shunts provide effective, long-lasting treatment for variceal hemorrhage due to portal hypertension in the alcoholic.
在过去十年中，我们开发并完善了一种用于控制酒精性肝硬化患者食管静脉曲张出血的部分门体分流术方法。我们机构对32例患者实施了使用8毫米聚四氟乙烯的窄直径间置门腔H型移植术，手术死亡率较低（6.3%），在平均43个月的随访期内，静脉曲张出血几乎完全停止（96.7%）。与全分流术相比，分流术后脑病发生率降低（分别为13%和40%）。通过围手术期门静脉造影研究的30例患者中，90%保留了正向门静脉血流。在长达9年的随访中，已证实分流道通畅且持续正向血流。其他三个中心的研究人员使用基本相似的技术对部分分流术进行了研究，结果相似。基于这些结果，我们得出结论，窄直径分流术为酒精性患者门静脉高压所致的静脉曲张出血提供了有效、持久的治疗方法。
