Borgonovo G, Costantini M, Grange D, Vons C, Smadja C, Franco D
Department of Surgery, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
Surgery. 1996 Feb;119(2):214-21. doi: 10.1016/s0039-6060(96)80172-3.
There is no agreement on the management of patients with cirrhosis and recurrent variceal bleeding after failure of medical or endoscopic treatments or both. Portal systemic shunts are highly effective in preventing rebleeding but are associated with a high incidence of chronic encephalopathy. This study compared the results of a slightly modified Sugiura procedure (esophageal transection plus esophagogastric devascularization plus splenectomy) with those of nonselective portal systemic shunts in patients with previous variceal bleeding.
Fifty-four patients were included in this randomized controlled study between January 1984 and April 1989. The major end point was chronic encephalopathy. Secondary end points were recurrent variceal bleeding, survival, ascites, and hepatocellular carcinoma.
Twenty-seven patients were assigned to each group. The rate of chronic encephalopathy was significantly (p = 0.002) lower after modified Sugiura procedure than after portal systemic shunt. Recurrent variceal bleeding was more frequent after modified Sugiura procedure than after portal systemic shunt, but the difference is not significant. One-, two-, and three-year survival rates were 93%, 81%, and 67%, respectively, in the modified Sugiura group and 78%, 66%, and 39%, respectively, in the portal systemic shunt group (p = 0.044).
These results suggest that the modified Sugiura procedure is better overall than the nonselective portal systemic shunt in the management of patients with cirrhosis and recurrent variceal bleeding. Although the rebleeding rate is higher after the modified Sugiura procedure, this does not seem to affect mortality in these patients.
对于肝硬化且在内科治疗或内镜治疗或两者治疗失败后出现复发性静脉曲张出血的患者，其治疗方法尚无定论。门体分流术在预防再出血方面非常有效，但与慢性脑病的高发生率相关。本研究比较了在既往有静脉曲张出血的患者中，改良的杉浦手术（食管横断术加食管胃去血管化加脾切除术）与非选择性门体分流术的治疗结果。
1984年1月至1989年4月期间，54例患者纳入了这项随机对照研究。主要终点是慢性脑病。次要终点是复发性静脉曲张出血、生存率、腹水和肝细胞癌。
每组分配27例患者。改良杉浦手术后慢性脑病的发生率显著低于门体分流术（p = 0.002）。改良杉浦手术后复发性静脉曲张出血比门体分流术更频繁，但差异不显著。改良杉浦组的1年、2年和3年生存率分别为93%、81%和67%，门体分流组分别为78%、66%和39%（p = 0.044）。
这些结果表明，在肝硬化和复发性静脉曲张出血患者的治疗中，改良杉浦手术总体上优于非选择性门体分流术。尽管改良杉浦手术后再出血率较高，但这似乎并未影响这些患者的死亡率。
