脐静脉桥式选择性分流术

Umbilical vein-braidged distal splenocaval shunt

目的 建立一种扩展远端脾腔分流术和冠腔分流术治疗门静脉高压症应用范围的手术方法。方法 在远端脾腔分流术和冠腔分流术的技术方法基础上 ,取中段脐静脉进行搭桥 ,构成脐静脉桥式远端脾腔分流术和脐静脉桥式冠腔分流术。结果 4例肝炎后肝硬变门静脉高压症病人中 ,3例接受了脐静脉桥式远端脾腔分流术 ,1例接受了脐静脉桥式冠腔分流术。 4例术后食道静脉曲张均减轻 ,肝功能改善。随访无再出血 ,吻合口通畅。结论 脐静脉桥式选择性分流术能够克服远端脾腔分流术和冠腔分流术在部分病例解剖学方面的局限性 。

Objective To establish a surgical method for expending the application of distal splenocaval shunt (DSCS) and coronocaval shunt (CCS). Methods Based on the surgical technique of DSCS and CCS, the middle part of umbilcal vein was resected and used to bridge the splenol vein or the coronary vein and the inferior cava, which constituted the umbilical vein-bridged DSCS or CCS. Results 3 of 4 cirrhotic patients with portal hypertention following viral hepatitis B underwent the umbilical vein-bridge DSCS, 1 of them received the umbilical vein-bridge CCS. In all of the pateints, the esophageal varicosis were alleviated and the liver function was improved after the operation. The follow-up showed that no hemorrhage recured and the anastomosis kept unblocked. Conclusions The umbilical vein-bridged DSCS or CCS could break through the anatomic limit of DSCS or CCS, and should be considered an effective procedure to expend the application of DSCS or CCS.