改良Sugiura术与选择性断流术治疗门脉高压症致食管胃底静脉曲张的有效性和安全性比较

目的:比较改良Sugiura术和选择性断流术治疗门静脉高压症(portal hypertension, PHT)合并食管胃底静脉曲张破裂出血(esophageal and gastric varices bleeding, EGVB)的临床疗效。方法:回顾性分析2005年9月1日至2019年12月1日45例行改良Sugiura术(改良组)和65例行选择性断流术(选择组)的PHT致EGVB患者的临床资料,比较两组患者术后累计生存率、再出血率及食管胃底静脉曲张缓解率。结果:改良组与选择组术后3个月死亡率分别为2.22%、1.54%;两组术后并发症发生率及死亡率差异均无统计学意义。随访截至2019年12月1日,改良组累计1、3、5年生存率分别为97.14%、84.62%、78.26%,累计1、3、5年再出血率分别为2.78%、12.00%、18.18%,术后3～6个月、1年及至随访截止日食管胃底静脉曲张缓解率分别为92.68%、87.80%、82.93%;选择组累计1、3、5年生存率分别为98.00%、89.19%、71.43%,累计1、3、5年再出血率分别为3.85%、21.95%、43.75%,术后3～6个月、1年及至随访截止日食管胃底静脉曲张缓解率分别为92.86%、87.50%、64.29%。两组术后远期累计生存率、并发症发生率差异无统计学意义;两组术后远期累计再出血率及食管胃底静脉曲张缓解率差异均有统计学意义(P0.05)。结论:两种断流术均为治疗PHT合并EGVB患者的有效术式,术后患者近、远期疗效相似,但对于食管胃底静脉曲张中、重度且伴有出血史的患者,改良Sugiura术的远期疗效更好,应优先选择。

Comparison of the effectiveness and security of modified Sugiura surgery and selective devascularization in the treatment of portal hypertension combined with esophageal and gastric varices

Objective: To compare the clinical efficacy of patients with portal hypertension (PHT) combined with esophageal and gastric varices bleeding (EGVB) by modified Sugiura surgery and selective devascularization.Methods: From September 2005 to December 2019, 45 patients underwent modified Sugiura surgery (modified group) and 65 patients underwent selective devascularization (selected group). the clinical data of these patients were collected. The cumulative survival rate, rebleeding rate, and remission rate of esophageal and gastric varices were retrospectively analyzed.Results: In the short term (within 3 months), the postoperative mortality rate in the modified and selected groups was 2.22% and 1.54%, respectively. There was no significant difference in the incidence of recent complications and mortality after surgery between the two groups. The final follow-up date was Dec 1, 2019. In the modified group, the cumulative 1-, 3-, and 5-year survival rates were 97.14%, 84.62%, and 78.26%; the cumulative 1-, 3-, and 5-year rebleeding rates were 2.78%, 12.00%, and 18.18%; at the three to six months after surgery, 1 year after surgery, and until the final follow-up date, esophageal and gastric varices remission rate was 92.68%, 87.80%, and 82.93%, respectively. In the selected group, the cumulative 1-, 3-, and 5-year survival rates were 98.00%, 89.19%, and 71.43%; the cumulative 1-, 3-, and 5-year rebleeding rates were 3.85%, 21.95%, and 43.75%; at the three to six months after surgery, 1 year after surgery, and until the final follow-up date, esophageal and gastric varices remission rate was 92.86%, 87.50%, and 64.29%, respectively. There was no significant difference in the cumulative survival rate and incidence of complication between the two groups. There were significant differences in the cumulative rebleeding rate and esophageal and gastric varices remission rate between the two groups (P<0.05).Conclusions: Both types of devascularization are effective methods for the patients with PHT combined with EGVB, and have similar short and long-term prognosises. Howere, for patients with moderate or severe esophageal and gastric varices combined with a history of bleeding, the modified Sugiura surgery has better long-term effect and should be selected first.