Král V, Klein J, Havlík R, Vomácka J, Utíkal P, Aujeský R, Vrba R
I. chirurgická klinika LF UP a FN, Olomouc.
Rozhl Chir. 2001 Nov;80(11):581-6.
The objective of the work is detailed evaluation of portosystemic shunts. The criterium of suitability and justification is their selectivity and preservation in the course of time.
The authors used a clinical group of patients who had either a Warren shunt or a mesocaval H-shunt with a limited blood flow (diameter 8 mm). In these patients the blood flow was assessed by dopplerometry in the portal vein and before the shunt, i.e. in the lienal or possibly mesenterial vein.
Of 32 shunts made during the last five years it was possible to make 12 assessments (8 Warren and 4 H-mesocaval shunts). An adequate decline in the blood flow in the portal vein was recorded and a corresponding increase in the lienal or mesenteric vein. Even after one year no marked drop in the flow through the portal vein was recorded.
A distal Warren shunt and H-mesocaval shunt with a restricted blood flow preserve the signs of selectivity even after one year. An adequate blood flow through the liver is also preserved. From this aspect selective shunts are still suitable treatment of portal hypertension. Obviously correct indication is the basic prerequisite of success.
本研究旨在对门体分流术进行详细评估。评估其适用性和合理性的标准是分流术的选择性以及长期效果的维持情况。
作者选取了一组临床患者，这些患者分别接受了Warren分流术或血流量受限（直径8mm）的肠系膜上静脉-下腔静脉H型分流术。通过多普勒超声分别测量这些患者门静脉以及分流术前（即脾静脉或肠系膜静脉）的血流量。
在过去五年中进行的32例分流术中，成功进行了12例评估（8例Warren分流术和4例肠系膜上静脉-下腔静脉H型分流术）。结果显示门静脉血流量出现了适当下降，同时脾静脉或肠系膜静脉血流量相应增加。即使在术后一年，门静脉血流量也没有出现明显下降。
远端Warren分流术和血流量受限的肠系膜上静脉-下腔静脉H型分流术即使在术后一年仍能维持选择性分流的特征。同时肝脏也能维持足够的血流量。从这方面来看，选择性分流术仍是门静脉高压症的合适治疗方法。显然，正确的适应症是成功的基本前提。
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