门静脉海绵样变的外科临床研究

目的探讨肠腔分流术、脾肾分流术及Phemister术治疗门静脉海绵样变(portal vein cav-ernous transformation,PVCT)的治疗方法及效果。方法回顾分析24例PVCT患者临床资料,其中行肠腔分流术18例(包括肠腔侧侧分流术12例、肠腔端侧分流术4例,肠腔自体血管架桥术2例);脾肾分流术与Phemister术各3例。结果门诊随访时间平均38(3~108)个月,无死亡病例。所有病例末次随访时肝功能、血氨正常。术后1年内行上消化道造影或胃镜检查22例,食道胃底静脉曲张消失者11例(肠腔分流术后10例、Phemister术后1例);轻度静脉曲张7例(肠腔分流术后3例、脾肾分流术后2例、Phemister术后2例);中度静脉曲张4例(肠腔分流术后3例、脾肾分流术后1例)。术后1年内行门静脉系统CT重建者5例,均为肠腔分流术后患者,显示肠腔吻合口通畅3例、吻合口狭窄2例。结论大口径门体分流术(肠腔分流)是治疗PVCT、预防PVCT相关上消化道出血的适宜方法。

Clinical Research of Cavernous Transformation of Portal Vein

Objective To research the therapeutic function of superior mesenteric vein-inferior vena cava anastomosis（MIA） and the Phemister procedure to patients with cavernous transformation of portal vein（PVCT）.Methods Retrospective analysis was used for the operational and peri-operational clinical data of 24 PVCT cases during November 1996 and September 2007 in Peking Union Medical College Hospital（PUMCH）.MIA was used in 18 cases,splenic vein-renal vein anastomosis and the Phemister procedures were used both in 3 cases.Results All the cases were followed up for 3 to 108 months without mortality.All the 24 cases were recovered with normal liver function and normal blood ammonia level.22 cases received upper gastroenterography or gastroscope within one year after operation,and there were 11 cases found disappearance of the esophago-gastric fundus varix,7 found mild varix,and 4 with midrange varix.5 cases of MIA were investigated the portal venous system by CT,which showed 3 of the vessel anastomosis unobstructed,and 2 of stenosis.Conclusion Large diameter porto-caval shunt（MIA） may be the best method to PVCT patients who suffered from upper digestive tract bleeding,otherwise simple disconnection is not commended to those cases.