中央型脾肾静脉分流术的临床观察

1974～1983年,我院采用中央型脾肾静脉分流术治疗肝内型门脉高压症48例,其中急症手术4例,择期手术20例,预防性分流术24例。术后近期死亡4例(有2例作急症分流),随访42例,最长9年8个月,平均为4年。远期死亡率14.3%,再出血率4.8%;脑病发生率14.3%;康复率88.9%;绝对生存率1、3及5年分别为93.2、78.5及72.7%。此术式系经胃结肠韧带切开的途径暴露胰腺体部,掀起胰体前下缘,游离胰体后脾静脉中央段,使之与肾静脉吻合,优点为操作简便、出血少、吻合口较大血流通畅、降压效果好,平均降压105mmH_2O,再出血率较低,分流量因受肾静脉容量限制,故门脉血流对肝灌注影响不太大,脑病发生率未高出周围型脾肾静脉分流术。

Clinical Investigation of Central Splenorenal Shunt

The author presents here 48 cases of portal hypertension treated with splenorenal shunt from 1974 to 1983. All of them were of the intrahepatic type. 20 cases underwent elective, 4 emergency and 24 prophylactic shunts. The average postshunt portal pressure decrement was 105 mmH2O. There were 4 postoperative deaths ( mortality 8.3% with 2 deaths in emergency, and none in the prophylactic shunt group). Over all follow-up rate was 95.5% (42 cases), and periods from 8 months to 9.6 years. 6 cases died within 1- 6.8 years postoperatively. The absolute survival rates in 1, 3 and 5 years after operation were 93.2%, 78.5% and 72.7% respectively. There were 2 cases of rebleeding(4.8%) and 6 of encephalopathy (14.3%). Most of the ence-phalopathy cases responded well to protein restriction and intestinal antibiosis. The central splenorenal anastomosis is performed via the inferior margin of the pancreas by dissecting out the central segment of the splenic vein, which is then anastomosed to the left renal vein. The anastomosis thus made is near to the portal vein and the inferior vena cava. The operation is easy to perform giving a low incidence of re-bleeding and encephalopathy.