Boillot O, Houssin D, Santoni P, Ozier Y, Matmar M, Chapuis Y
Clinique Chirurgicale, Hôpital Cochin, Paris.
Gastroenterol Clin Biol. 1991;15(12):876-80.
Of 220 patients undergoing liver transplantation between March 1982 and April 1991, eighteen (8.1 percent) already had a surgical portasystemic shunt. Four patients had a distal splenorenal shunt, six a side-to-side portacaval shunt, three an end-to-side portacaval shunt, and five, a mesocaval shunt. The splanchnic venous system was assessed by Doppler ultrasound examination and angiography before liver transplantation. Perioperative mortality rate was higher but not significantly different from that observed in the population of patients without previous portasystemic shunt (33.3 percent versus 21.7 percent). Liver transplantation was particularly difficult in the six patients with a previous side-to-side portacaval shunt, in which the perioperative mortality rate was high (66.6 percent). Liver transplantation is feasible in patients with a previous portasystemic shunt but carries a higher risk. It is easier when no previous dissection of the hepatic pedicle has been done. Suppression of the shunt after revascularization of the graft must be performed in order to provide optimal venous flow to the hepatic graft.
在1982年3月至1991年4月期间接受肝移植的220例患者中，18例（8.1%）已有外科门体分流术。4例为远端脾肾分流术，6例为侧侧门腔分流术，3例为端侧门腔分流术，5例为肠系膜上腔静脉分流术。肝移植前通过多普勒超声检查和血管造影对内脏静脉系统进行评估。围手术期死亡率较高，但与未行过门体分流术的患者群体相比无显著差异（33.3%对21.7%）。对于6例既往有侧侧门腔分流术的患者，肝移植尤为困难，其围手术期死亡率很高（66.6%）。既往有门体分流术的患者可行肝移植，但风险较高。若既往未对肝蒂进行过解剖，则手术更容易。为使移植肝获得最佳静脉血流，必须在移植肝血管重建后抑制分流。
