Mazzaferro V, Todo S, Tzakis A G, Stieber A C, Makowka L, Starzl T E
Department of Surgery, University Health Center, University of Pittsburgh, Pennsylvania.
Am J Surg. 1990 Jul;160(1):111-6. doi: 10.1016/s0002-9610(05)80879-7.
Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child's classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the use of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact, their 9-year survival was 87%, whereas all other shunts were associated with a survival no better than 52% (p less than 0.006).
在9年的时间里，58例曾接受过门体分流术的患者在环孢素 - 类固醇免疫抑制方案下接受了原位肝移植（OLTx）。所使用的分流类型为远端脾肾分流术（18例患者）、肠系膜上腔静脉分流术（17例患者）、端侧门腔静脉分流术（11例患者）、侧侧门腔静脉分流术（5例患者）和近端脾肾分流术（7例患者）。分流与移植之间的平均间隔时间为6年。既往有分流术的患者与同期进行原发性肝移植的全体患者的生存率无统计学差异。年龄、性别、分流通畅情况、门静脉状态以及静脉或动脉移植物的使用均不影响生存率。Child分级对移植物生存率有显著影响，尽管随后在患者生存率方面未观察到差异。术中策略的逐步改进以及静脉 - 静脉转流和威斯康星大学保存液的使用对失血量、手术时长、重症监护病房住院时长以及最终的生存率都有显著影响。如果计划后续进行移植，未进行或仅进行极少肝门部解剖的远端脾肾分流术和肠系膜上腔静脉分流术是更安全的分流术；事实上，它们的9年生存率为87%，而所有其他分流术的生存率均不超过52%（p小于0.006）。
