贲门周围血管离断加肠腔静脉侧侧分流术治疗门静脉高压症

目的防止肝硬变门静脉高压症患者术后再出血,保持门静脉向肝血供,降低肝性脑病发生率。方法对３７例门静脉高压症患者施行了联合断流加肠腔静脉分流手术,即贲门周围血管离断后,肠系膜上静脉与下腔静脉采用直接侧侧吻合。结果本组手术成功率１００％。术后自由门静脉压（ＦＰＰ）３１６±０５８ｋＰａ,较术前３９１±０６４ｋＰａ明显降低,差异有极显著性意义（Ｐ＜００１）。术后随访５～２２个月,所有患者肝功能均有不同程度恢复,其中１２例肝功能Ⅲ级的患者,有５例恢复到Ⅰ级、７例恢复到Ⅱ级、无１例发生肝性脑病及再出血。腹水消失率１００％,食管胃底静脉曲张改善消失率８２９％。结论断流分流联合应用,既能保持一定的门静脉压力及门静脉肝脏血供,又能疏通门静脉系统的高血流状态,是一种较理想的治疗门静脉高压症的手术方法

Treatment of portal hypertension by using pericardial vascular disconnection and mesocaval side-to-side shunting

OBJECTIVE: To prevent post-operative bleeding, to maintain the blood supply to the liver from the portal vein and to reduce the incidence of hepatic encephalopathy. METHOD: The blood vessel was cut around the cardial opening and the venae cavae was anastomosed in 37 patients with portal hypertension. RESULT: The success rate of surgery was 100%. The free portal pressure (FPP) was 3.16 +/- 0.581 kPa, which was lower than the FPP (3.91 +/- 0.642 kPa) before operation (P < 0.01). Follow-up for 5 to 22 months showed that liver function recovered from III to I in 5 patients, and from III to II in 7. Ascites disappeared in all and varix improved in 82.9% patients. CONCLUSION: Cutting flow combined with fraction flow can effectively maintain the blood supply to the liver in treating portal hypertension.