IMPROVED SURVIVAL AFTER PROPHYLACTIC PORTAL NONDECOMPRESSION SURGERY FOR ESOPHAGEAL-VARICES - A RANDOMIZED CLINICAL-TRIAL
IMPROVED SURVIVAL AFTER PROPHYLACTIC PORTAL NONDECOMPRESSION SURGERY FOR ESOPHAGEAL-VARICES - A RANDOMIZED CLINICAL-TRIAL
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DOI：
10.1002/hep.1840120102
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发表时间：
1990-07-01
期刊：
影响因子：
13.5
通讯作者：
INOKUCHI, K
中科院分区：
文献类型：
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作者：
INOKUCHI, K
为了评价食管静脉曲张的预防性手术，日本门脉高压研究会于1980年开始了一项前瞻性随机对照试验。手术方法包括选择性分流术和非分流中断术。112例日本患者，内镜检查结果提示出血风险，但没有出血发作，被随机分配到手术组60例或非手术组52例。9例特发性门脉高压症患者，组织学证实的非胰腺炎性疾病，均属于手术组，从研究中排除，其余103例患者（51例手术和52例非手术）进行了分析。对患者进行的中位49个月（最长73个月）的长期随访显示，手术组共有11例（22%）死亡，包括2例手术死亡，而非手术组有23例（49%）死亡。手术组5年累积生存率为72%，明显高于非手术组的45%（P < 0.05）。手术组5年累积静脉曲张出血率为7%，显著低于非手术组的46%（P < 0.001）。结论：门静脉非减压手术可有效防止静脉曲张的捆绑，提高生存率。
To evaluate prophylactic surgery for esophageal varices, a prospective randomized controlled trial was begun in 1980 by the Japanese Research Society for Portal Hypertension. Methods of operation included selective shunts and nonshunting interruption procedures. One hundred and twelve Japanese patients, in whom endoscopic findings suggested risk of bleeding but who had no bleeding episode, were randomly allocated to the operated group of 60 patients or nonoperated group of 52 patients. Nine patients with idiopathic portal hypertension, histologically proven noncirrhotic disease, which all fell in the operated group, were excluded from the study and the remaining 103 patients (51 operated and 52 nonoperated) were analyzed. Long-term follow-up of patients for a median of 49 mo with a maximum of 73 mo showed a total of 11 (22%) deaths, including 2 operative deaths, in the operated group compared with 23 (49%) deaths in the nonoperated group. The cumulative survival rate at 5 yr in the operated group was 72%, which was significantly higher than the 45% of the nonoperated group (p < 0.05). The cumulative variceal bleeding rate at 5 yr was 7% in the operated group, which was significantly lower than that of the nonoperated group of 46% (p < 0.001). It was concluded that portal nondecompression surgery was effective in preventing the variceal binding and in improving survival.