门腔静脉人工血管搭桥分流术治疗门静脉高压症

目的观察用门腔静脉间人工血管搭桥分流术治疗门静脉高压症患者的临床疗效,并与传统的门体分流术比较。方法采用带外支撑环的８ｍｍ口径聚四氟乙烯（ＧｏｒｅＴｅｘ）薄壁人工血管行门腔静脉间搭桥分流术,所用人工血管长度为２～３ｃｍ,共治疗２０例患者。结果搭桥分流术后门静脉压力下降幅度与同期１７例脾肾静脉分流术及１１例门腔静脉侧侧分流术相比差异无显著意义（０８３±０３１ｋＰａ,０８１±０５０ｋＰａ及１０２±０４５ｋＰａ,Ｐ＞００５）。三组患者全部获得随访,平均随访时间为１５～２８个月,手术死亡率及再出血率没有差别,但搭桥分流组术后脑病发生率显著低于门腔侧侧分流组（５０％及３６４％,Ｐ＜００５）。２０例患者术后近期均经下腔静脉行门静脉造影,人工血管通畅率为９５％,出院后１９例患者均经一次以上Ｂ超检查,随访已超过１５个月,人工血管均通畅。结论门腔静脉间小口径人工血管搭桥分流术对患者创伤小,操作简便,术后脑病发生率低,疗效比较确切

Portacaval shunt with H-grafts of small diameter in treating cirrhotic patients with portal hypertension

OBJECTIVE: To evaluate the effectiveness of portacaval shunt with H-grafts of small diameter in the treatment of cirrhotic patients with portal hypertension. METHOD: 48 patients cirrhotic with portal hypertension were randomized into three groups: portacaval shunt with H-grafts of 8 mm diameter with external ring reinforced (20 patients), proximal splenorenal shunt (17), and side-to-side portacaval shunt (11). The preoperative liver function in Child's grade and the history of variceal bleeding were the same in the three groups. RESULT: The postoperative decrease in portal pressure was comparable in the three groups (0.83 +/- 0.31 kPa, 0.81 +/- 0.50 kPa, and 1.02 +/- 0.45 kPa, P > 0.05). There was no significant difference in postoperative rebleeding rate during the follow-up for 15-28 months, and in hospital mortality between the three groups. However, postoperative encephalopathy developed much less in patients undergoing portacaval shunt with H-grafts than those receiving side-to-side portacaval shunt (5.0% vs. 36.4%, P < 0.05). Postoperative transfemoral portography performed within one month showed shunt patency in 95% of the 20 patients undergoing H-graft shunting. B-mode ultrasonography follow-up of up to 15 months also showed shunt patency in all 19 survivals receiving H-graft shunt. CONCLUSION: This procedure shows less trauma, lower postoperative encephalopathy rate, while as effective in preventing recurrent variceal bleeding as the traditional portosystemic shunt.