限制性分流与断流联合术治疗门静脉高压症

Treatment of portal hypertension by use of limited shunt together with devascularization

目的探讨限制性分流与断流联合手术治疗门静脉高压症的效果。方法对39例门静脉高压症患者行断流加肠腔静脉限制性分流术的临床疗效进行回顾性分析。结果患者术后自由门静脉压力水平下降8cm H2O，且皆保持门静脉的向肝血流，术后随访6～24个月，39例患者有18例肝功能有不同程度恢复，1例在围手术期有短暂的肝性脑病发作，38例患者腹水消失，食管胃底静脉曲张消失好转率82．1％，无再出血发生。结论断流限制性分流联合应用，既能保持一定的门静脉压力及门静脉肝脏血供，又能防止上消化道出血，降低肝性脑病发生率，是治疗门静脉高压症的较为理想的手术方法。

Objective To investigate the effects of combination of limited shunt and devascularization in the treatment of patients with portal hypertension. Methods The follow-up results of 39 portal hypertension patients undergoing the combined operation were retrospectively analysed. Results The postoperative free portal pressure decreased by 8 cm H2 O, and hepatopetal portal venous blood flow was maintained. All the patients were followed-up for 6 to 24 months, the results showed that various degreas of recovery of liver function in 18 patients. One patient had transient hepatic encephalopathy. Ascites disappeared in 38 patients and gastroesophageal varices improved in 82. 1% of patients. No case of rebleeding occured. Conclusions Limited shunt combined with devascularization can effectively maintain the blood supply to the liver, prevent upper gastroesophageal hemorrhage and reduce the occurrence rate of hepatic encephalopathy. It is a suitable operative method for the treatment of portal hypertensive patients.