Thomas P G, D'Cruz A J
Department of General Surgery, St John's Medical College Hospital, Bangalore, India.
Br J Surg. 1994 Feb;81(2):241-4. doi: 10.1002/bjs.1800810227.
In patients with bleeding gastric varices from causes other than splenic vein thrombosis, endoscopic sclerotherapy and ablative surgery have yielded poor results. Over a 3-year period starting in June 1989, a total of 30 distal splenorenal shunts were performed prospectively on 19 paediatric and 11 adult patients with bleeding gastric varices and good liver function. The mean (s.d.) age was 17(12) (range 6-50) years; there were 20 male and ten female patients of whom six had cirrhosis, four non-cirrhotic portal fibrosis and 20 portal vein thrombosis. Two patients died and two more had shunt thrombosis; all four were considered failures of treatment. Hypersplenism was present in 15 patients but reverted to normal in 13. In 26 patients the gastric varices disappeared. Concomitant oesophageal varices were present in 22 patients and showed marked regression, with no rebleeding over a mean (s.d.) follow-up of 21(10) (range 7-39) months. A distal splenorenal shunt was effective in controlling gastric variceal haemorrhage in 26 of 30 patients in whom liver function was well preserved.
对于因脾静脉血栓形成以外的原因导致胃静脉曲张出血的患者，内镜硬化疗法和消融手术效果不佳。从1989年6月开始的3年期间，前瞻性地对19例儿童和11例成年胃静脉曲张出血且肝功能良好的患者进行了30例远端脾肾分流术。平均（标准差）年龄为17（12）岁（范围6 - 50岁）；男性20例，女性10例，其中6例患有肝硬化，4例为非肝硬化性门静脉纤维化，20例为门静脉血栓形成。2例患者死亡，2例出现分流血栓形成；这4例均被视为治疗失败。15例患者存在脾功能亢进，但13例恢复正常。26例患者的胃静脉曲张消失。22例患者同时存在食管静脉曲张，且有明显消退，在平均（标准差）21（10）个月（范围7 - 39个月）的随访中无再出血。在肝功能良好的30例患者中，26例远端脾肾分流术有效控制了胃静脉曲张出血。
