SELECTIVE AND TOTAL SHUNTS IN TREATMENT OF BLEEDING VARICES - RANDOMIZED CONTROLLED TRIAL

被引：142

作者：

GALAMBOS, JT

WARREN, WD

RUDMAN, D

SMITH, RB

SALAM, AA

机构：

[1] VET ADM HOSP, SERV SURG, ATLANTA, GA USA

[2] GRADY MEM HOSP, SERV SURG, ATLANTA, GA USA

[3] VET ADM HOSP, SERV MED, ATLANTA, GA USA

[4] EMORY UNIV HOSP, SERV SURG, ATLANTA, GA 30322 USA

[5] EMORY UNIV, SCH MED, DEPT MED, ATLANTA, GA 30303 USA

[6] EMORY UNIV, SCH MED, CLIN RES FACIL, ATLANTA, GA 30303 USA

[7] EMORY UNIV, SCH MED, DEPT SURG, ATLANTA, GA 30303 USA

[8] EMORY UNIV HOSP, SERV MED, ATLANTA, GA 30322 USA

[9] GRADY MEM HOSP, SERV MED, ATLANTA, GA USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 1976年 / 295卷 / 20期

关键词：

D O I：

10.1056/NEJM197611112952001

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In 2 of the latter a total shunt was performed for technical reasons. The fatality rates (6 in the 24 total, 6 in 22 selective-performed and 7 in 24 selective-randomized), the frequency of shunt occlusion (2 in each group) and the frequency of recurrent gastrointestinal bleeding (3 in each group) were similar. Encephalopathy developed more often after a total shunt (10 of 24 or 1/58 patient-mo.) than after selective performed (1 of 22 or 1/593 patient-mo., P < 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P < 0.05).

引用

页码：1089 / 1095

页数：7

共 10 条

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