【摘要】 我们于1973年10月～1980年12月应用门腔分流术治疗34例门脉高压症,其中同时脾切除者28例,并用门静脉动脉化者4例,分流前测门静脉压为28～57cm水柱(平均39cm水柱),分流后测门静脉压降低8～36cm水柱(平均降低25cm水柱);13例腹水患者术后迅速消退者12例,3周内消失者1例;33例食道静脉曲张术后全部消失者3(?)例,明显减轻者2例;手术死亡3例,其余31例随访12～78个月,均未发生过再出血和腹水,其中24例于术后3～6个月恢复工作。作者认为:门腔分流同时切脾可降低门脉压、止血、消除脾亢和腹水,为较好的门体分流术。但肝性脑病发生率高(17.6%)。为此,我们采取了六项预防措施,重点在于分流口径应控制在1.0±0.2cm为宜,分流后门脉压维持在17±3cm水柱较好。最后还介绍了门腔分流术同时切脾的手术方法和经验。更多还原

【Abstract】 The 34 patients with portal hypertension were treated with portacaval shunt from Feb 1973 to Dec. 1980. Nine patients underwent emergency portacaval shunt, and twenty-eight selective portacaval shunt. Splenectomy was performed simultaneously with portacaval shunt on twenty-eight patients, and arterialization of the portal stump following portacaval end-to—side shunt was performed on four patients. The portal pressure was 28 to 57 cm H₂o before shunting, and fell down by 8 to 36cm H₂O, with on average of 25 cm H₂O after shunting. The results of this procedure shawed that ascites in 12 cases of 13 eliminated rapidly, and that in one eliminated in three weeks after shunting. Esophageal varices eliminated in thirty-one of the thirty-three cases, and were alle viated obviously in the two. Three patients died of shunting, and the other thirty-one patients were followed up for twelve to seventy-eight months after surgry, one patient died of encephalopathy 31 months after operation and four patients had encephalopathy. Of the other twenty-six survivor, twenty-four cases could do some work from the 3rd to 6th month after surgery. All the cases with portal hypertension who were follwed up did not have rebleeding and ascites again.we think that portacaval shunt with splenectomy can reduce portal pressure, control bleeding and relieve hypersplenism and ascites. This is a good procedure of portal-systemic shunt, but the incidence of encephalopathy is high （17.6%）. Therefore, we took six preventive measures, of which two should be emphasized: the caliber of portacaval shunt should be kept at 1.0±0.2cm, and portal pressure should maintain at 17±3 cm H₂O after Shunt.Surgical procedures were also described in this article.更多还原