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1981年作者着手对肝硬化食管静脉曲张病人作远端脾肾分流(以下简称 DSRS)和内窥镜食管静脉曲张硬化剂疗法(以下简称 EVS)进行前瞻性、随机临床对照研究,以比较两组患者的生存率、预防再度出血和维持肝功能的结果。选择1981年5月～1985年11月 Emory 大学医院所收治的71例食管静脉曲张出血患者,按其病因、临床和实验室资料配对并随机分成两个治疗组。临床Child 分级,40例属 A/B 级(56％),31例为 C 级(44％)。内窥镜检肯定为食管曲张静脉出血,作经皮肝穿刺活检证实肝硬化并确定肝病的活动程度,血管造影均显示脾静脉和门静脉通畅,分别作半乳糖清除率(GEC)肝功能定盘测定,肝容量 CT 测定,肝脏有效血流量小剂量半乳糖清除法测定以及心排出量测定等。将病人随机分为 EVS 和 DSRS 组,计 EVS 组36例,DSRS 组35例,分组后一周内即进行治疗,DSRS组1例非甲非乙型肝炎未手术,死于肝功能衰竭作治疗失败,其余病例均在3～6月,1年以及逐年追踪随访。结果 (一)生存率—EVS 组的二年生存率为84％,DSRS 组为59％,EVS 组明显优于 DSRS 组(P<0.01),但 EVS 组31例存活者中包括8例 EVS治疗失败后经手术控制出血的。(二)手术死亡率一DSRS 组死亡4例(12％)均为 Child C 级,以后又有10例死亡,其中8例死于肝功能衰竭。EVS 组死亡
In 1981, the author conducted a prospective, randomized, controlled clinical trial of distal splenorenal shunt (DSRS) and endoscopic esophageal variceal sclerotherapy (hereinafter referred to as EVS) for cirrhotic esophageal varices to compare two groups Patient survival, prevention of rebleeding, and maintenance of liver function. A total of 71 patients with esophageal variceal bleeding admitted to Emory University Hospital from May 1981 to November 1985 were selected and matched according to their etiology, clinical and laboratory data and randomly assigned to two treatment groups. Clinical Child classification, 40 cases were A / B grade (56%), 31 cases were C grade (44%). Endoscopy identified as esophageal variceal bleeding for liver biopsy confirmed percutaneous liver biopsy and determine the extent of liver disease, angiography showed splenic vein and portal vein patency, respectively, galactose clearance (GEC) liver function plate Determination of liver volume CT determination of effective blood flow in the liver small doses of galactose clearance determination and determination of cardiac output. The patients were randomly divided into EVS group and DSRS group, 36 cases in EVS group and 35 cases in DSRS group were treated within one week after treatment. One case of non-A, non-B hepatitis in DSRS group died of liver failure for treatment , The remaining cases were in 3 to 6 months, 1 year and follow-up each year. Results (1) Survival rate - The two-year survival rate in the EVS group was 84%, in the DSRS group was 59%, significantly higher in the EVS group than in the DSRS group (P <0.01), but EVS group consisted of 8 EVS patients After the failure of surgery to control bleeding. Surgical mortality In the DSRS group, 4 (12%) died of Child C and 10 were subsequently dead, of which 8 died of liver failure. EVS group died