Mercado M A, Orozco H
Clínica de Hipertensión Portal, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
Rev Gastroenterol Mex. 1992 Apr-Jun;57(2):116-21.
Surgery for bleeding portal hypertension has evolved widely in the last decades. The surgical procedures that preserve portal blood flow are the first operative choice for well selected patients. Operative procedures that deprive the portal blood flow to the liver, are most likely to promote deterioration of liver function in the late postoperative period. The operation most frequently performed are the selective shunts (Warren) and the thoraco abdominal devascularization (Sugiura). The best results are obtained in patients with a good liver function that are operated in an elective fashion. Non-selective shunts have a restricted indication and low diameter porto systemic shunts are still under evaluation. The combination of drug therapy and/or sclerotherapy with surgery appears to improve survival. Liver transplants are indicated for those patients with associated liver failure. For patients with good liver function, surgery is the therapy of choice.
在过去几十年中，治疗出血性门静脉高压的手术方法有了很大的发展。对于精心挑选的患者，保留门静脉血流的手术是首选的手术方式。剥夺肝脏门静脉血流的手术操作，极有可能在术后晚期促使肝功能恶化。最常施行的手术是选择性分流术（沃伦手术）和胸腹去血管化术（杉浦手术）。肝功能良好且接受择期手术的患者能取得最佳疗效。非选择性分流术的适应证有限，小口径门体分流术仍在评估中。药物治疗和/或硬化疗法与手术相结合似乎能提高生存率。肝移植适用于那些伴有肝功能衰竭的患者。对于肝功能良好的患者，手术是首选的治疗方法。
