Zusammenfassung
Ziel der vorliegenden Untersuchung war es, die Ergebnisse unserer portosystemischen
Shuntchirurgie der letzten 20 Jahre darzustellen.
Patienten und Methodik: Vom 1.1.1980 bis 31.12.2000 führten wir 90 portosystemische Shuntoperationen durch.
Die Patienten wurden in zwei Gruppen unterteilt. Gruppe I wurde zwischen 1980 und
1988 operiert (n = 58), Gruppe II zwischen 1988 und 1998 (n = 32). Beide Gruppen unterschieden
sich nicht bezüglich des Alters, des Geschlechts und der Ursache der Leberzirrhose.
In der ersten Gruppe wurden überwiegend portokavale Shuntoperationen durchgeführt,
in der zweiten Gruppe mehrheitlich splenorenale.
Ergebnisse: Die Ergebnisse verbesserten sich signifikant. Die Frühletalität betrug in Gruppe
I 16 %, in Gruppe II 9 %, die Spätletalität 35 bzw. 6 % (p < 0,05). Auch die Enzephalopathierate
fiel in Gruppe II signifikant von 43 auf 12 % ab, die Rate an Ösophagusvarizenrezidivblutungen
sank von 10 auf 6 %.
Folgerung: Distale splenorenale Shuntoperationen sind der konventionellen portosystemischen
Shuntanlage signifikant überlegen. In Ländern, in denen für Rezidivblutungen nicht
flächendeckend die notfallmäßige endoskopische Sklerotherapie vorgehalten werden kann
und bei denen aus Kostengründen die TIPS-Therapie nur spärlich eingesetzt wird, ist
der selektive portosystemische Shunt das einzige Verfahren zur Lebensrettung dieser
Patienten, wenn die Sklerotherapie versagt.
Abstract
Objective: It was the aim of this study to demonstrate our experiences over twenty years with
portasystemic shunt surgery in patients with chronic liver disease and variceal bleeding.
Patients and methods: From January 1st, 1980 to December 31st, 2000 we performed 90 portasystemic shunt operations (PSO). The patients were divided
in two groups. The patients of the first group were operated upon between 1980-1988
(n = 58), patients of the second group (n = 32) between 1988-1998. Both groups did
not differ in age, gender and cause of hepatic disease. In the first group the most
performed type of shunt was the portacaval shunt, in group II the splenorenal shunt.
Results: We observed an improved early and late mortality rate, encephalopathy rate and reduction
of recurrent variceal bleeding in the second group: the early mortality rate decreased
from 16 to 9 % (p < 0.01), the late mortality rate from 35 to 6 % (p < 0.05), the
encephalopathy rate from 43 to 12 % and the variceal rebleeding rate from 10 to 6
%.
Conclusion: Selective shunts, such as the distal splenorenal shunt are significantly superior
to the standard (end-to-side or side-to-side) portasystemic shunt. In countries where
acute treatment of recurrent variceal hemorrhage with sclerotherapy is not available
in remote areas or in countries where transplantation procedures are in the very beginning
and where TIPPS operations are too expensive, portasystemic shunt operations are the
only possibility to save the patients life when sclerotherapy fails.
Schlüsselwörter
Leberzirrhose - Ösophagusvarizenblutung - portosystemischer Shunt - Langzeitüberleben
Key words
Liver cirrhosis - esophageal variceal bleeding - portasystemic shunt - selective shunt
- long-term results
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Prof. Dr. A. Depolo
University Medical School
Department of Digestive Surgery
Clinical Hospital Center
Kresimirova 42
HR-51000 Rijeka
