门体分流术在肝硬化门静脉高压症外科治疗中的地位

Role of portosystemie shunt in the treatment of portal hypertension with liver cirrhosis

传统外科手术是我国目前治疗肝硬化食管胃底静脉曲张出血的主流手术，虽然手术方式繁多，但不能违背依据门静脉血流动力学状况进行术式选择的原则。如果门静脉压力升高的主要原因是肝内阻力增加所致，只有门体分流术才能取得满意的降压和止血效果，因此门体分流术在肝硬化门静脉高压症外科治疗中仍占据重要地位，适合于肝硬化食管胃底静脉曲张破裂出血、门静脉高压性胃病出血和断流术后再次出血的患者。在我国，对于内镜治疗失败的患者，门体分流术也是主要的治疗手段。在各种分流加断流的联合手术中，脾切除脾肾静脉分流加贲门周围血管离断术最合理，应成为首选。

Traditional surgery is the current mainstream approach for varicose bleeding of esophagus and gastric funds. Although the operative modalities vary widely, we should not deviate from the principle that a selection of surgery type must be based on portal vein hemodynamics. If portal vein pressure is caused mainly by elevated intrahepatic resistance, portosystemic shunt may achieve satisfactory reduction and hemostasis. So portosystemic shunt still plays an important role in the surgical treatment of portal hypertension with liver cirrhosis. The patients with varicose bleeding of esophagus and gastric funds, portal hypertension gastropathic hemorrhage and rebleeding after devascularization should undergo portosystemic shunt. And it is also a main treatment modality for those with failed endoscopic treatment. Splenectomy and pericardial devascularization with spleno-renal shunt operation is optimal and should be a first choice among various combination operations of devascularization with shunt.