[Status of the portosystemic shunt in the therapy concept of portal hypertension].
The 5-years-survival rate of patients with liver cirrhosis is limited to about 25%. Still, one of the most important therapeutic procedures in case of bleeding oesophageal and fundic varices is a portasystemic shunt 6 randomized studies have been performed to compare the complete portacaval shunt with the incomplete splenorenal Warren-shunt: The hospital mortality rate (8-10%) and the 5-years-survival rate (43-47%) do not differ; but the rate of postoperative encephalopathy significantly is higher after PCA (40-26%) and the rate of recurrent bleeding significantly is higher after Warren-shunt (13-6%). In case of massively or early recurrent bleeding, we favour an emergency PCA: the mortality rate amounts to 12% in case of the socalled "early operation" (after initially successful balloon tube or sclerotherapy, 52 patients) and 47% in case of "absolute emergency shunt" because of continuing bleeding (119 patients). In the elective situation (58 patients) we favour the Warren-shunt in elderly patients with diabetes mellitus, preexisting encephalopathy or Child-B-classification.
Hirner
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A
Abteilung Allgemein-, Gefäss- und Thoraxchirurgie, Klinikum Steglitz der Freien Universität Berlin.
Karavias
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T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis
Stellenwert des portosystemischen Shunts im Therapiekonzept der portalen Hypertension.