选择性和非选择性分流术控制食管曲张静脉出血的结果

我们自1980年1月至1985年12月使用分流术治疗门静脉高压症伴食管曲张静脉出血41例,其中一组行非选择性肠-腔桥式分流术12例;另一组行选择性远端脾肾静脉分流术29例。两组患者的临床和实验室检查资料以及肝功能分级情况无明显差异。治疗结果非选择性分流组术后1例死亡,经随诊平均59.5月复发出血率27.3%,肝性脑病率9.1%,1～5年生存率90.9%;选择性分流组亦1例术后死亡,随诊平均33.4月,复发出血率3.6%,无脑病发生,1～5年均存活。从治疗效果看选择性分流优于非选择性分流。本文还对治疗方法选择的认识,施行远端脾肾静脉分流术的体会和理想手术方法等问题进行了初步探讨。

THE RESULT OF SELECTIVE AND NONSELECTIVE SHUNT TO CONTROL BLEEDING

Optimal management of patients with portal hypertension who have bleeding esophageal varices is the subject of much controversy. Jn the past, nonselective shunts have proved to be efficient in the control of variceal bleeding. However, prevalence of postoperative encephalopathy, recurrent bleeding and lack of evidence that these operations prolonged survival in cirrhotic patients have led to the division of other procedures. In doing this, attention has recently been focused on the selective shunt procedures. The main goal of this study is to evaluate the result of selective shunts and to deter mine whether they have any advantages over the nonselective shunts. From 1980 to 1985, forty-one cases with variceal bleeding secondary to cirrhosis were gathered and classified into two groups. Among them 29 patients underwent selective (distal splenorenal) shunt, and 12 patients underwent nonselective ('H'-graft interpostion) shunt. The operations were performed at the Affiliated Hospital of Dalian Medical College and that of Zunyi Medical College. All the 41 patients were evaluated prior to surgery with respect to history, physical examination, liver biopsy, and liver function test. No obvious statistical significance was found between the two operative groups with respect to preoperative clinial and laboratory data. Postoperative mortality for the selective group was 3.4%, and the nonselective group was 8.3%. Whereas portal perfusion was maintained in the early postoperative interval after selective shunt, nonselective shunt resulted in portal flow diversion in all patients. Mean follow-up for selective shunt survivors is 33.4 months and for the nonselective is 59.5.Recurrent bleeding was most frequent after nonselective shunt (27.3%). Encephalopathy rarely occurred after a selective shunting procedure, but it was a frequent complication of nonselective shunting procedure (9.1%). Neither the type of procedure selected nor the cause of liver disease influences long-term survival.