摘要
本文总结近8年来施行的42例选择性远端脾腔分流术的临床疗效和血流动力学效应以评价此术在肝硬变门静脉高压症中的治疗价值。本组门静脉高压症病人在分流术后仍维持术前的门静脉高压状态及门静脉向肝血流;而脾腔静脉吻合通畅率高,脾静脉压力显著下降。术后病人只有1例发生早期再出血,肝功能稳定,无肝性脑病发生,病人生活质量佳,本文结果表明,选择性远端脾腔分流术是一种较理想的选择性分流术式。
Distal splenocaval shunting was performed in 42 patients for the treatment of variceal bleeding.The procedure was constructed by directly anastomosing the distal splenic vein to the infrarenal vena cava in a end to side manner togather with esophagogastric devascularization and splenopancreatic disconnection.Fourty of the operation were done electively and 2, emergently.The overall operative mortality rate was 9.5%, with 3.0% in the late 27 cases.Survival was 86.3% at 1 year.82.4% at 3 years, and 74.8% at 5 years.Recurrent bleeding occurred in only one patient (2.4%).Hepatic encephalopathy did not develope in any patient up to date.Immediate shunt patency was docummented in 41 of 42 patients, all 11 shunt studied at 2 months were patent.The pressure of the splenic vein reduced markedly after shunting with simutaneous maintenance, of portal hypertension and hepatopedal portal perfusion when studied at 2 months after shunting.Ekperience with these patients demonstrated that, when feasible, the distal splenocaval shunt is the preferred procedure under elective conditions in good—risk patients with hepatopedal portal flow.
