应用PTFE人造血管行门腔H型吻合治疗门静脉高压症

Application of PTFE graft in type H portacaval shunt for portal hypertension

目的 了解血管移植物PTFE在H型门腔分流道的通畅率,分流口径对向肝血流的影响以及减压效果和并发症。方法 用内径10mm普通型PTFE和带支撑环的PTFE分别为12例及8例肝硬化门静脉高压症患者进行了门腔静脉间的H型分流术。其中肝功能ChildA级13例,B级5例,C级2例。平均年龄434岁。结果 无手术死亡。术后平均随访172个月,脑病Ⅰ～Ⅱ级2例,无曲张静脉破裂再出血。术后门脉系统彩色多普勒超声及血管造影检查,向肝血流量无明显影响,分流道通畅率90%。普通PTFE者血栓形成2例(167%);带支撑环PTFE者无血栓形成。结论 该技术在减低门静脉压力,维持向肝血流,预防再出血等方面均取得了良好结果,其中带支撑环者优于普通型。

Objective To assess the patent rate of vessel PTFE graft at type H portacaval shunt; the effect of shunt diameter on hepatopetal blood flow, decompression efficiency and complications. Methods Abstract: Objective To assess the patent rate of vessel PTFE graft at type H portacaval shunt; the effect of shunt diameter on hepatopetal blood flow, decompression efficiency and complications. Methods Type H portacaval shunt using a 10?mm diameter PTFE graft with or without supporting rings were performed in 12 and 8 patients respectively, including Child A in 13 cases, Child B in 5 and Child C in 2. The patients' average age was 43.4 years old. Results No operative mortality or rebleeding from ruptured varices occurred, but encephalopathy occurred in 2 cases for a mean follow up period of 17.2 months. Postoperative color Doppler ultrasonography and angiography showed that hepatopetal blood flow was no changes after operation. The patent rate of shunt was of 90%. Shunt thrombosis was found in 2 cases(16.7%) using PTFE graft without supporting ring, but no case in using of PTFE graft with supporting ring. Conclusions This portacaval shunt is effective to decompress portal pressure, ensure the hepatopetal blood flow and prevent rebleeding. PTFE graft with supporting ring is more advantagous than that lack of supporting ring.