Alam M K, el-Sayed G S, Abdulmajeed A M, al-Dohayan A
Department of Surgery, College of Medicine, Riyadh, Kingdom of Saudi Arabia.
Br J Surg. 1996 Dec;83(12):1702-5. doi: 10.1002/bjs.1800831212.
This retrospective analysis studied the effect of sclerotherapy on subsequent oesophageal transection in the management of patients with bleeding oesophageal varices and compared the result with that in those who did not receive sclerotherapy as the primary treatment. Fifty patients were treated by gastro-oesophageal devascularization and oesophageal transection for bleeding oesophageal varices over a 4-year period. Twenty-six patients did not receive sclerotherapy (group 1) and 24 received between one and four sessions of sclerotherapy (group 2) before surgery. Oedema and thickness of the lower end of the oesophagus and some adhesions were noted during surgery in patients who had had previous sclerotherapy; however, stapled oesophageal transection and anastomosis could be performed in all these patients. There was no oesophageal leak in any patient, although there was a higher rate of chest complications (nine versus six patients) in group 2. Six patients (12 per cent) died (three in each group) during the postoperative period; three had Child grade C disease. It is concluded that the decision to operate to control bleeding varices should be made early. One or two sessions of sclerotherapy before surgery does not increase intraoperative difficulty or the postoperative leak rate following oesophageal transection. The outcome of surgery is directly related to the state of liver reserve (Child grade).
这项回顾性分析研究了硬化疗法对食管静脉曲张破裂出血患者后续食管横断术的影响，并将结果与未接受硬化疗法作为主要治疗方法的患者进行比较。在4年期间，50例患者因食管静脉曲张破裂出血接受了胃食管去血管化和食管横断术治疗。26例患者未接受硬化疗法（第1组），24例患者在手术前接受了1至4次硬化疗法（第2组）。在接受过硬化疗法的患者手术过程中，发现食管下端有水肿和增厚以及一些粘连；然而，所有这些患者均可进行吻合器食管横断术和吻合术。尽管第2组胸部并发症发生率较高（9例对6例），但所有患者均未发生食管漏。术后有6例患者（12%）死亡（每组3例）；3例为Child C级疾病。得出的结论是，应尽早做出手术控制静脉曲张破裂出血的决定。术前进行1或2次硬化疗法不会增加术中难度或食管横断术后的漏率。手术结果与肝脏储备状态（Child分级）直接相关。
