脾肾分流加门奇断流联合术治疗门静脉高压症的合理性和价值

Splenorenal Shunt with Partoazygous Devarscularization for Portal Hypertonion.

目的 :探讨脾肾分流加门奇断流联合术的临床疗效及其对门静脉血流动力学的影响。方法 :通过脾肾分流加门奇断流联合术治疗门静脉高压症 1 50例前瞻性随访 2 0年的疗效。对其中部分病人采用彩色多普勒B超 (DC FI)、数字减影血管造影 (DSA)和术中PVP动态测量 ,综合观察手术前后门静脉系统血流动力学变化 ,并与 2 5例门奇断流术进行对比研究。结果 :近期无 1例出血 ,再出血率为 7.7% ,术后肝性脑病发生率为 4 .6 % ,手术死亡率为3 .3 % ,术后 3 ,5 .1 0和 1 5年生存率为 93 .6 %、83 .6 %、64 .5 %和 54 .5 %。门静脉系统血流动力学变化 :联合术后门静脉直径 (DPV)和门静脉压 (PVP)较断流术明显减小和降低 (P <0 .0 5) ,两术式后门静脉血流量 (PVF)均显著减少 ,但联合术后PVF减少与断流术无显著差异 (P >0 .0 5) ,联合术后门静脉头向侧支消失 ,肝脏门静脉灌注良好。结论 :本联合术即切断了门奇静脉间反常血流侧支 ,又降低了PVP和缓解了门静脉系高动力血流状态 ,临床疗效满意 ,是一种合理。

To investigate the clinical and hemodynamic effects of splenorenal shunt combined with portoazygous devascularization for the treatment of portal hypertension. Methods: The procedure was employed in 15 cases of portal hypertension from 1978 to 1999, and the clinical results as well as the changes of hemodynamics of the portal venous system were studied by Doppler colour flow imaging(DCFI), digital subtraction angiography(DSA) and portal venous pressure(PVP). Results: No bleeding occurred during the early postoperative period. Recurrence of bleeding occurred in 7.7% of the patients and encephalopathy in 4.6%, the overall mortality was 3.3%.Conclusions: The procedure recommended is a rational and practical operation in the treatment of portal hypertension.