小口径人造血管门腔静脉H型分流治疗门静脉高压症

SMALL-DIAMETER H-GRAFT PORTACAVAL SHUNT IN THE TREATMENT OF PORTAL HYPERTENSION

目的 评价小口径人造血管门腔静脉 H型分流治疗门脉高压症的临床效果。方法 1995年 11月～ 1999年 9月采用小口径 e PTFE(膨化聚四氟乙烯 )人造血管门腔静脉 H型分流治疗 2 3例门静脉高压症患者 ,同时行胃左动脉及冠状静脉结扎 ,2 2例同时切除脾脏。结果 自由门脉压平均由分流前 31.2 7± 4.71cm H2 O降至分流后 16 .82± 3.2 8cm H2 O,门脉向肝血流量较术前减少约 1/ 3。平均随访 2 0 .2月 ,2 3例全部存活 ,均未发生消化道再出血 ,彩超和 /或下腔静脉造影检查示 2 1例分流道通畅 ,2例闭塞 (8.7% ) ,3例发生肝性脑病 (13% )。结论 小口径 e PTFE人造血管门腔静脉 H型分流能有效的降低门脉压力 ,亦能维持大部分门脉向肝血流 ,肝性脑病发生率较低 ,带支持环者通畅率高 ,疗效确切。

Objective To evaluate the clinical effect of small-diameter H-graft portalcaval shunt in the treatment of portal hypertension.Method Twenty-three patients with portal hypertension were treated by small-diameter H-graft of ePTFE(expanded polytetrafluoroethylene) portalcaval shunt from May,1995 to November,1999.Thirteen had externally reinforced grafts and 10 had non-reinforced one,20 had 10mm diameter grafts and 3 had 8mm grafts.Left gastric artery and coronary vein were ligated in all and splenectomy was performed in 22 cases.Result The FPP(free portal pressure,FPP)was reduced from 31.27±4.71cmH 2O before shunt to 16.82±3.28cmH 2O after shunt averagely.The portal blood flow was reduced about 1/3 after Shunt.All patients were survival and no upper gastro-intestinal rebleeding occurred in the follow-up period(20.2months in average).Color Doppler ultrasonagraphy and/or cavography revealed that the shunts were patent in 21 cases and occluded in 2 (8.7%).Encephalopathy was developed in 3 cases (13%).Conclusion Small-diameter ePTFE H-graft portacaval shunt can reduce the portal pressure effectively.Majority of the hepatic blood flow from portal vein can be maintained.The shunts with reinforced graft keep higher patency.The morbidity of encehpalopathy was lower.It's effective in preventing recurrent variceal bleeding.