Torgunakov S A, Torgunakov A P
Angiol Sosud Khir. 2010;16(4):184-8.
A distal splenorenal venous anastomosis (DSRVA) is used as a method to decompress the portal system in hypertension and as a method to treat type 1 diabetes mellitus. The essence of the operation consists in establishing an «end-to-side» anastomosis between the distal end of the transected close to the ostium splenic vein with the left renal vein. Possible shortcomings of this operation include but are not limited to high thrombus-related hazard both in case of using it in portal hypertension and in diabetes mellitus. In the latter, thrombosis of the anastomosis is observed to develop in 27% of diabetic patients within 7-8 postoperative months. The causes of this complication were not studied. The present communication presents the findings of studying the natural pattern of confluence of the portal-system veins performed on a total of 111 cadavers and in 50 patients suffering from chronic hepatitis and undergoing surgery in order to form a left-sided renoportal venous anastomosis. It was demonstrated that DSRVA is associated with impaired natural confluence of the veins and the width of the two veins forming an anastomosis exceeds the width of the blood-outflowing vein more than 1.5-fold. This is followed by analysing the results of studying removability of the pancreas and left kidney in the vertical position by means of excretory urography and probe-assisted duodenography in 54 patients with chronic hepatitis. Removability of the pancreas in 57.4% of cases was greater than that of the left kidney, which is the condition for kinking of the splenic vein in the DSRVA zone. In order to choose an optimal anastomosis and to prevent DSRVA thrombosis it is advisable to preoperatively examine the venous pressure in the left renal vein, removability of the pancreas relative to the left kidney, and during establishing the anastomosis to observe the natural pattern of confluence of veins by the width.
远端脾肾静脉吻合术（DSRVA）被用作一种在高血压患者中减压门静脉系统的方法，以及一种治疗1型糖尿病的方法。该手术的本质在于在靠近脾静脉开口处切断的脾静脉远端与左肾静脉之间建立“端侧”吻合。该手术可能存在的缺点包括但不限于在门静脉高压症和糖尿病患者中使用时血栓形成风险较高。在糖尿病患者中，术后7 - 8个月内观察到吻合口血栓形成的发生率为27%。尚未对该并发症的原因进行研究。本报告介绍了对111具尸体以及50例患有慢性肝炎并接受手术以形成左侧肾门静脉吻合术的患者进行门静脉系统静脉自然汇合模式研究的结果。结果表明，DSRVA与静脉自然汇合受损有关，形成吻合的两条静脉的宽度超过流出静脉宽度的1.5倍以上。随后，通过排泄性尿路造影和探头辅助十二指肠造影分析了54例慢性肝炎患者在垂直位置切除胰腺和左肾的研究结果。在57.4%的病例中，胰腺的可切除性大于左肾，这是DSRVA区域脾静脉扭结的条件。为了选择最佳吻合方式并预防DSRVA血栓形成，建议术前检查左肾静脉的静脉压力、胰腺相对于左肾的可切除性，并在建立吻合时通过静脉宽度观察静脉的自然汇合模式。
