脾肾静脉分流联合断流手术治疗门静脉高压症

目的评价近端脾肾静脉分流联合断流手术治疗门静脉高压症的临床疗效。方法回顾性总结1998年2月至2008年12月我院采用脾肾静脉分流联合断流手术治疗门静脉高压症56例病例,统计术中门静脉压力改变、术后CDFI检测脾静脉及分流通道情况,并从术后并发症、肝功能、再出血三方面总结临床疗效。结果手术前后门静脉压由(37.55±5.37)cmH2O降至(25.03±4.66)cmH2O,平均下降(12.53±7.23)cmH2O(P<0.05)。术后1、3、12、24个月脾静脉及脾肾静脉分流通道血栓形成分别为0、1、2、3例;脾肾静脉分流口直径0.75～1.25cm,平均(0.98±0.37)cm;门静脉血流均为向肝血流,脾静脉血流均为逆肝血流。术后肝功能均恢复正常。术后并发症共4例,均经保守治疗后治愈或好转。2例于术后3年、5年出现上消化道大出血,经查为脾肾静脉分流通道血栓形成者。结论脾肾静脉分流联合断流手术既保留了分流术及断流术的优点,又克服了二者的缺点,是治疗门静脉高压症的一种理想术式。

Splenorenal Shunt Combined with Pericardial Devascularization in the Treatment of Portal Hypertension

Objective To investigate the effect of the splenorenal shunt （SRS） combined with pericardial devascularization （PCDV） on the patients with portal hypertension. Methods Data of 56 patients with portal hypertension who underwent by splenorenal shunt combined with pericardial devascularization from Feberory 1998 to December 2008 were analyzed retrospectively. Free portal pressure （FPP） during the operation and the information of the diameter, blood flow and thrombosis of portal vein, distributary channel were measured respectively. Summarize the efficacy through the statistics of complication,liver function and rebleeding after the operation. Results The portal pressure was reduced from the preoperative vaule of （37.55±5.37） cm to （25.03± 4.66） cm （P〈 0.05） . The statistics of thrombus in splenic vein and distributary channel through CDFI were as follows： 0 case in 1 month, l patient in 3 months,2 patients in 12months,3 patients in 24 month; the diameter of distributary channel was 0.75-1.25cm （0.98±0.37） cm; CDFI showed the blood flow in portal vein toward liver and the blood flow in splenic vein backwards liver. The liver function of all patients recovered to normal level during the follow-up period. There were 4 patients with complication were recorded, all patients with complication were cured after the expectant treatment.Two patients with alimentary tract hemorrhage were found in3, 5yeaers after the operation,and the reason of hemorrhage was the forming of thrombus in splenic vein and distributary channel. Conclusion SRS combined with PCDV remains the advantages of the SRS and PCDV and overcomes the shortcomings, so it is a useful operation mode in the treatment of portal hepertension.