Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices.
Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices.
复制标题
一项针对酒精性肝病和静脉曲张出血患者进行门静脉分流术的 12 年随机试验结果。
DOI：
10.1016/0016-5085(81)90073-1
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发表时间：
1981
期刊：
影响因子：
29.4
通讯作者：
J. Weiner
中科院分区：
文献类型：
--
作者：
T. Reynolds;A. J. Donovan;W. Mikkelsen;A. Redeker;F. L. Turrill;J. Weiner
在1967-1974年的7年时间里，89例酒精性肝病和至少一例被认为是食管静脉曲张引起的严重上消化道出血的患者进入了一项随机对照试验，比较药物治疗与端侧门静脉分流术。随访持续至1979年9月，随机分组后所有存活患者至少有5年的观察时间。在45例随机接受手术治疗的患者中，有4例由于各种原因没有接受门静脉分流术。在分流的患者中有11次上消化道出血，没有致命的，也没有被认为是由食管静脉曲张引起的。37%符合条件的患者有中度或重度肝性脑病，归因于分流术。在44例随机接受药物治疗的患者中，7例在多次出血发作后最终接受了门静脉分流术。自随机分组以来，有190例出血，需要589次输血，其中23例因出血或出血引起的肝功能衰竭而死亡。手术治疗组12例，药物治疗组8例。生命表分析显示，在整个研究过程中，手术治疗组的生存率略有增加，但没有统计学意义。从我们的数据中，我们无法确定哪些风险因素可以改善对患者进行药物或手术治疗的选择。
During a 7-yr period (1967–1974), 89 patients with alcoholic liver disease and at least one severe upper gastrointestinal hemorrhage thought to be from esophageal varices entered a randomized, controlled trial of medical therapy vs. end-to-side portacaval shunt. Follow-up continued to September, 1979, so that all surviving patients had at least 5 yr of observation after randomization. Among 45 patients randomized to surgical therapy, 4 did not receive portacaval shunt, for various reasons. Among shunted patients there were 11 episodes of upper gastrointestinal bleeding, none fatal and none thought to be from esophageal varices. Thirty-seven percent of eligible patients have had moderate or severe hepatic encephalopathy ascribed to the shunt. Of 44 patients randomized to medical therapy, 7 eventually received portacaval shunt after multiple bleeding episodes. Since randomization there have been 190 episodes of bleeding requiring 589 transfusions and resulting in 23 deaths from bleeding or hepatic failure precipitated by bleeding. There are 12 survivors in the surgically treated group and 8 in the group treated medically. Life-table analysis shows a small increase in survival in the surgically treated group throughout the study, which is not statistically significant. From our data, we could not identify risk factors that would improve the selection of patients for medical or surgical therapy.