Atta H M, Henderson J M, Galloway J R, Millikan W J
Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
Arch Surg. 1991 May;126(5):582-5. doi: 10.1001/archsurg.1991.01410290058012.
Splenocaval shunting was performed in 26 patients for the treatment of variceal bleeding. The indications for this alternative selective shunt were congenital anomalies of the left renal vein, inadequate outflow from the left renal vein on preoperative venography, or an anatomic relationship of the splenic vein favoring direct splenocaval rather than splenorenal anastomosis. Technical considerations in which splenocaval shunts differ from distal splenorenal shunting relate to exposure of the vena cava. Operative mortality was 7.7% (2/26). Immediate shunt patency was documented in 23 of 24 patients studied, and all 14 shunts studied at 13 to 57 months were patent. Portal perfusion was maintained in 95% (20/21) of the patients when studied at 7 to 10 days after shunting and in 57% (8/14) at late follow-up. This experience with distal splenocaval shunting has reaffirmed its place as an alternative technique to selective distal splenorenal shunts, particularly when the left renal vein is abnormal.
对26例患者实施脾腔分流术以治疗静脉曲张破裂出血。这种替代性选择性分流术的适应证为左肾静脉先天性异常、术前静脉造影显示左肾静脉流出道不畅，或脾静脉的解剖关系有利于直接进行脾腔吻合而非脾肾吻合。脾腔分流术与远端脾肾分流术在技术考量上的不同之处在于腔静脉的暴露。手术死亡率为7.7%（2/26）。在接受研究的24例患者中，有23例记录显示分流即刻通畅，在术后13至57个月接受研究的所有14例分流中均保持通畅。在分流术后7至10天进行研究时，95%（20/21）的患者维持了门静脉灌注，在晚期随访时这一比例为57%（8/14）。这种远端脾腔分流术的经验再次证实了其作为选择性远端脾肾分流术替代技术的地位，尤其是在左肾静脉异常的情况下。
