Jovine E, Cescon M, Ercolani G, Masetti M, Mazziotti A, Cavallari A
Divisione di Chirurgia Generale, Dipartimento Discipline Chirurgiche Rianimatorie e dei Trapianti, University of Bologna, Policlinico S. Orsola Via Massarenti, 9, 40138 Bologna, Italy.
Hepatogastroenterology. 2001 Jan-Feb;48(37):107-8.
Management of gastrointestinal hemorrhage from rupture of esophageal and gastric varices due to portal hypertension remains a debated question. In patients with sclerotherapy-resistant esophagogastric varices, and preserved hepatic function, a surgical shunt is considered the treatment of choice. A 63-year-old male was admitted in our Department with a diagnosis of idiopathic fibrosis of the liver, portal hypertension, esophageal and gastric varices and previous history of variceal bleeding. A distal splenorenal shunt was planned. During the isolation, a large diameter left adrenal vein was identified. An end-to-end anastomosis utilizing the distal splenic vein and the proximal adrenal stump was performed. The procedure was uneventful. An ultrasound color-Doppler on the 3rd postoperative day, showed normal intrasplenic resistance index, demonstrating the efficacy of the shunt. A splenic angiography carried out on the 8th postoperative day showed the complete patency of the splenoadrenal shunt. At the 15th postoperative day, the patient was discharged. In patients with portal hypertension, sclerotherapy-resistant esophagogastric varices and preserved hepatic function, a surgical portosystemic shunt is mandatory. Splenoadrenal shunt, utilizing a left adrenal vein represent an excellent option in selected cases.
门静脉高压导致食管和胃静脉曲张破裂引起的胃肠道出血的管理仍然是一个有争议的问题。对于硬化治疗抵抗的食管胃静脉曲张且肝功能保留的患者，手术分流被认为是首选治疗方法。一名63岁男性因特发性肝纤维化、门静脉高压、食管和胃静脉曲张以及既往静脉曲张出血史入住我科。计划进行远端脾肾分流术。在分离过程中，发现一条大直径的左肾上腺静脉。利用远端脾静脉和近端肾上腺残端进行端对端吻合。手术过程顺利。术后第3天的超声彩色多普勒显示脾内阻力指数正常，表明分流术有效。术后第8天进行的脾血管造影显示脾肾分流完全通畅。术后第15天，患者出院。对于门静脉高压、硬化治疗抵抗的食管胃静脉曲张且肝功能保留的患者，手术门体分流是必要的。利用左肾上腺静脉的脾肾分流在特定病例中是一个极佳的选择。
