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首页> 外文期刊>World Journal of Surgery: Official Journal of the Societe Internationale de Chirurgie, Collegium Internationale Chirurgiae Digestivae, and of the International Association of Endocrine Surgeons >Long-term results with the modified sugiura procedure for the management of variceal bleeding: Standing the test of time in the treatment of bleeding esophageal varices
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Long-term results with the modified sugiura procedure for the management of variceal bleeding: Standing the test of time in the treatment of bleeding esophageal varices

机译：经改良的sugiura程序处理静脉曲张破裂出血的长期结果：经时效检验食管静脉曲张破裂出血

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Background: The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. In the present study we retrospectively analyzed the results of the modified Sugiura procedure, performed as emergency and semi-elective treatment in the patient with bleeding esophageal varices. Methods: Ninety patients with cirrhosis and portal hypertension were managed in our department for variceal esophageal bleeding between January 1985 and December 1992. The modified Sugiura procedure was performed in 46 patients on an emergency (25 patients) or semi-elective (21 patients) basis. Liver cirrhosis stage according to Child classification was A in 4 patients, B in 16 patients, and C in 26 patients. Results: Acute bleeding was controlled in all patients. Postoperative mortality was 23.9% (11 of 46 patients). The mortality rate was 34.6% in Child class C patients (9 of 26 patients), and 12.5% in Child class B patients (2 of 16 patients). Twenty-four patients had long-term follow-up extending from 14 months to 22 years (mean 83.1 months). Ten of 24 patients (41.6%) did not develop rebleeding for 5-22 years (mean 10.3 years). Overall 5-year survival in these 24 patients was 62.5%. Conclusions: The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available.
机译：背景：自从内窥镜硬化疗法，经颈静脉肝内门体分流术（TIPS）和肝移植的临床发展以来，已减少了治疗肝硬化患者食管静脉曲张破裂出血的手术方法。但是，如果急性硬化疗法失败，并且在无法进行进一步治疗的情况下，紧急手术可能会挽救生命。在本研究中，我们回顾性分析了改良的Sugiura程序的结果，该程序在食管静脉曲张破裂出血患者中作为紧急和半选择性治疗进行。方法：1985年1月至1992年12月间，我科共收治了90例肝硬化和门静脉高压症患者，治疗了食管静脉曲张破裂出血。改良的Sugiura手术在46例急诊（25例）或半择期（21例）基础上进行。根据儿童分类，肝硬化分期为A 4例，B 16例，C 26例。结果：所有患者的急性出血均得到控制。术后死亡率为23.9％（46名患者中的11名）。儿童C级患者的死亡率为34.6％（26名患者中的9名），儿童B级患者的死亡率为12.5％（16名患者中的2名）。 24位患者的长期随访从14个月延长至22年（平均83.1个月）。 24例患者中有10例（41.6％）在5-22年（平均10.3年）没有再出血。这24名患者的总体5年生存率为62.5％。结论：改良的Sugiura手术仍然是食管静脉曲张破裂出血的有效挽救方法，可替代疗法失败或未指明。此外，对于不适合分流手术的解剖结构患者或在没有分流手术专业知识的非专业中心接受治疗的患者，这可能是挽救生命的程序。

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