Collins J C, Ong M J, Rypins E B, Sarfeh I J
Surgical Service, Long Beach Veterans Affairs Medical Center, Calif, USA.
Arch Surg. 1998 Jun;133(6):590-2; discussion 592-4. doi: 10.1001/archsurg.133.6.590.
To determine rates of survival, long-term patency, and recurrent variceal hemorrhage among patients with alcoholic cirrhosis treated by partial portacaval shunt.
Single-institution cohort follow-up study of 72 consecutive patients who underwent small-diameter portacaval H-graft shunt with collateral ablation during a 10-year period (1981 through 1990). Subjects were enrolled and followed up for up to 15 years. Shunt patency was assessed by portography and/or ultrasonography. We performed 7-year Kaplan-Meier analyses of survival (in 65 patients in Child classes A and B), shunt patency, and absence of variceal bleeding.
Tertiary academic referral center of the US Department of Veterans Affairs.
Patients with alcoholic cirrhosis were considered for operation after at least 1 proven episode of variceal hemorrhage. Patients with portal vein thrombosis were excluded; patients in Child class C underwent operation only for compelling indications. Of the 72 who underwent partial shunting, 38 were in Child class A, 27 were in class B, and 7 were in class C.
Partial portacaval shunt (6-, 8- or 10-mm polytetrafluoroethylene H-graft with collateral ablation) and serial follow-up.
Study end points were death, recurrent variceal hemorrhage, and unavailability for follow-up. Other measures included graft patency and nonvariceal rebleeding.
Cumulative probability of 7-year patency for grafts at risk was 95%. The 7-year probability for absence of variceal bleeding in patients at risk was 92%. In 65 patients in Child classes A and B, operative mortality was 7.7% and the cumulative probability of 7-year survival was 54%.
For variceal bleeding associated with alcoholic cirrhosis, the small-diameter polytetrafluoroethylene portacaval H-graft with collateral ablation affords durable patency and protection against variceal rebleeding.
确定接受部分门腔分流术治疗的酒精性肝硬化患者的生存率、长期通畅率和复发性静脉曲张出血率。
对1981年至1990年期间连续72例行小直径门腔H型移植分流术并进行侧支消融的患者进行单机构队列随访研究。对受试者进行登记并随访长达15年。通过门静脉造影和/或超声检查评估分流的通畅情况。我们对65例Child A级和B级患者进行了7年的生存、分流通畅和无静脉曲张出血的Kaplan-Meier分析。
美国退伍军人事务部的三级学术转诊中心。
酒精性肝硬化患者在至少1次经证实的静脉曲张出血发作后考虑手术。排除门静脉血栓形成患者；Child C级患者仅在有迫切指征时才进行手术。在72例行部分分流术的患者中，38例为Child A级，27例为B级，7例为C级。
部分门腔分流术（6毫米、8毫米或10毫米聚四氟乙烯H型移植并进行侧支消融）及系列随访。
研究终点为死亡、复发性静脉曲张出血和无法进行随访。其他指标包括移植通畅和非静脉曲张再出血。
有风险的移植物7年通畅的累积概率为95%。有风险的患者7年无静脉曲张出血的概率为92%。在65例Child A级和B级患者中，手术死亡率为7.7%，7年生存的累积概率为54%。
对于与酒精性肝硬化相关的静脉曲张出血，带侧支消融的小直径聚四氟乙烯门腔H型移植可提供持久的通畅性并预防静脉曲张再出血。
