- 作者：Marshall J. Orloff ; M.D.&lowast ; ; morloff@ucsd.edu ; Jon I. Isenberg ; M.D.&dagger ; ; Henry O. Wheeler ; M.D.&dagger ; ; Kevin S. Haynes ; M.D.&dagger ; ; Horacio Jinich-Brook ; M.D.&dagger ; ; Roderick Rapier ; M.D.&dagger ; ; Florin Vaida ; Ph.D.&Dagger ; ; Robert J. Hye ; M.D.&lowast ; ; Susan L. Orloff ; M.D.§ ;
- 关键词：cirrhosis ; bleeding esophageal varices ; emergency portacaval shunt ; endoscopic sclerotherapy ; alcoholic ; nonalcoholic
- 刊名：Journal of Surgical Research
- 出版年：2012
- 出版时间：1 May, 2012
- 年：2012
- 卷：174
- 期：1
- 页码：98-105
- 全文大小：149 K
Background
It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial.Methods
Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96 % .
Results
Results strongly favored EPCS over EST (P?< 0.001). Among EPCS patients, 83 % were alcoholic and 17 % nonalcoholic. Outcomes were (1) permanent control of bleeding 100 % versus 100 % ; (2) 5-y survival 71 % versus 78 % ; (3) encephalopathy 14 % versus 19 % ; (4) yearly charges $38,300 versus $43,000.
Conclusions
EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.