脾静脉-大隐静脉吻合治疗门静脉高压症

Splenic great saphenous venous anastomosis for portal hypertension

目的 探讨脾静脉与大隐静脉吻合术治疗门静脉高压的作用。方法 １９９４ 年３ 月～１９９８ 年３ 月共采用脾静脉大隐静脉吻合术治疗门脉高压症１２ 例，男７ 例，女５ 例，年龄３４ ±６．３５ 岁（２６ ～５４ 岁） 。常规脾切除，游离脾静脉及一定长度的大隐静脉，将大隐静脉经皮下隧道进入脾床，与脾静脉吻合。术中测定吻合前、后门静脉压力。术前及术后１ 个月用彩色多普勒超声系统测定门静脉血流量、血流速率。结果 吻合前、后平均门静脉压力分别为２９．３８ ±２．７５ ，２４．６８ ±２．５５ ｃｍＨ２Ｏ（ Ｐ ＜ ０ ．０１ ） 。术前门静脉最大血流速率１９．８６ ±８．６５ ｃｍ／ｓ，术后降至１６．２７ ±７．５４ ｃｍ／ｓ ，下降１８．９３ ％ （ Ｐ ＜ ０ ．０１ ） ；术前门静脉最大血流量１７０６．３２ ±８１４．２７ ｍｌ／ｍｉｎ ，术后降至１ ３２３．０２ ±６３０ ．５２ ｍｌ／ｍｉｎ ，下降２２．４６ ％ （ Ｐ ＜ ０ ．０１ ） 。食管钡餐检查静脉曲张消失者８ 例，明显减轻３ 例，无变化１ 例。随访１ ～４ 年无再出血，无肝性脑病及死亡病例。结论 脾静脉大隐静脉吻合术可有效地降低门静脉压力，且无肝性脑病发生，简便易行。

Objective To study the effect of splino great saphenous venous anastomosis(SSVA) for portal hypertension(PH). Methods Tweenlve patients with PH (7 male and 5 female) underwent SSVA, average age 34±6.35 years (ranging from 26 to 54 years old). After splenectomy, the spleen vein and great saphenous vein were anastomosed. Results The pre and post operative average portal pressure was 29.38±2.75?cmH 2O, 24.68±2.55?cmH 2O respectively(P<0.01). The postoperative maximum velocity of portal vein was significantly decreased (from 19.86±8.65?cm/sec to 16.21±7.54?cm/sec), (P<0.01). The postoperative maximum volume also decreased significantly (from 1706.32±814.27?ml/min to 1323.02±630.52?ml/min)(P<0 01), The esophageal varices disappeared in 8 patients and improvement could be found in 3 cases despite 1 case unchangable. All of the patients were followed up for 1～4 years, neither hepative encephalopathy nor death was noted, and no hemorrhage of upper digestive tract occurred. Conclusions SSVA can effectively decrease the portal pressure and no hepative encephalopthy was found in this series. Therefore SSVA is vitwed as a simple, safe and effective operation for portal hypertension.