肝左静脉搭桥术治疗门静脉海绵状变性所致的肝前性门脉高压--2例报告和文献复习

肝左静脉搭桥术治疗门静脉海绵状变性所致的肝前性门脉高压--2例报告和文献复习*李金良，陈维秀，徐长宪，王若义，陈雨历山东大学第二医院小儿外科 山东省济南市北园大街247号 250033近来，我院成功对2例门静脉海绵状血管瘤导致的肝前行门脉高压患者实施了自体颈内静脉移植肝左静脉搭桥术和胃食管静脉断流术。术前应用彩色多普勒成像、三维或二维计算机断层血管造影（3-D/2-D CTA）和经髂动脉-肠系膜上动脉间接门静脉造影评估门脉系统和颈静脉、大隐静脉的适用性。术前肝功能和肝组织活体检查结果正常。手术中首先完成胃食管静脉断流术。然后，在肝的脏面显露肝圆韧带裂（Rex or umbilical recess）并分离肝圆韧带周围的肝实质，暴露和识别肝内门静脉左枝。然后，解剖出远段门静脉或肠系膜上静脉。取一段自体左颈内静脉（保留左颈外静脉），用7-0 Prolene无创伤线分别与解剖出的左肝静脉和远段门静脉或肠系膜上静脉行端侧吻合和恢复门静脉向肝血流。手术中门静脉系统淤血立即明显改善。无手术并发症。手术后3个月3-D CTA和3个月、6个月彩色多普勒评价证明自体移植的颈内静脉通畅。本文讨论了自体颈内静脉肝左静脉搭桥术和相关的治疗方法治疗门静脉血栓和海绵状变性导致的肝前性门脉高压的优缺点、可行性以及临床应用技术等，并系统复习了相关文献。就我们所知，这是我国此手术应用的第一个病例报告#。关键词：肝前性门脉高压，门脉海绵状血管瘤，肠系膜上静脉门静脉左支搭桥术*通讯作者。电话：0086-0531-85875406；传真：0086-0531-88962544；E-mail: lijinliangsdh@163.com.

Treatment of Portal Hypertension from Portal Vein Cavernoma with Meso-Rex Bypass Operation--2 Cases report and References Review

Treatment of Portal Hypertension from Portal Vein Cavernoma with Meso-Rex Bypass Operation--2 Cases report and References Review*Jinliang LI, Weixiu CHEN, Changxian XU, Ruoyi WANG, Yuli CHENDivision of peadiatric surgery, Department of Surgery, The second Hospital and Medical School of Shandong University, Jinan, Shandong Province, China, 2500332 cases of extrahepatic portal vein cavernoma, complicated with the clinical manifestations of portal hypertension, were successfully treated with meso-Rex bypass by autologous internal jugular vein together with esophagogastric devascularization. Before operation, the color-flow Doppler imaging, 3-D or 2-D CTA (computed tomography angiography) and indirect portography by the celiac artery and the superior mesenteric artery were performed to confirm the availability of the portal vein system, the jugular vein and the great saphenous vein. The liver histology and liver function test were normal. During surgery, esophagogastric devascularization was completed firstly, and then the patent intrahepatic left portal vein was identified by exposing the lower surface of Rex or the umbilical recess and dissecting the liver parenchyma around the round ligament. The patent distal end of the superior mesenteric vein was dissected at the level of the confluence with the coronary vein. A segment of left internal jugular vein, harvested saving the external one, was placed between distal end of the portal vein or superior mesenteric vein and the left portal vein at Rex recessus level with venotomy longitudinally and 7-0 Prolene anastomosis and then sutured to the left branch of the portal vein, both with end-to-side fashion. The clinical detension of portal territory was immediately evident. No operative complication was observed and 3, 6 months later 3-D CTA and color-flow Doppler evaluations proved the patency of the venous grafts. Together with the technical aspects of the procedures, the possible role of this technique is discussed in relation to the available therapies for the prehepatic portal vein thrombosis and cavernoma. And the relative references reviewed. To date, there has been no report of meso-Rex bypass procedure in China#.Keywords: extrahepatic portal hypertension; Portal vein cavernoma; meso-Rex bypass*Corresponding author. Tel.: 0086-0531-85875406; Fax: 0086-0531-88962544.E-mail address: lijinliangsdh@163.com.