Inokuchi K, Sugimachi K
Department of Surgery, Saga Prefectural Hospital, Koseikan, Japan.
Am J Surg. 1990 Jul;160(1):48-53. doi: 10.1016/s0002-9610(05)80868-2.
It has been proved that selective decompression of esophageal varices can occur by way of the left gastric venous route or the transsplenic route. The left gastric venacaval shunt functions well over a long postoperative period, if the shunt is technically satisfactory; however, the distal splenorenal shunt (DSRS) can be problematic. Unless the proximal and distal portions of the splenic vein are both entirely isolated from the pancreas, blood flow will be diverted from the portal vein to the distal splenic vein, where the pressure has been lowered by the shunt. This portal malcirculation may lead to portal thrombosis or stenosis on occasion. To prevent this adverse effect, complete isolation of the splenic vein (splenopancreatic disconnection) is necessary. Extensive gastric disconnection is irrelevant in this regard. Although the conventional DSRS has been viewed with disfavor, we must realize that splenopancreatic disconnection makes the DSRS a satisfactory technique. The clinical evidence and theoretic basis of the selective shunt for esophageal varices are described herein.
已经证明，可通过胃左静脉途径或经脾途径实现食管静脉曲张的选择性减压。如果技术上令人满意，胃左静脉腔静脉分流术在术后较长时间内功能良好；然而，远端脾肾分流术（DSRS）可能会出现问题。除非脾静脉的近端和远端部分都与胰腺完全分离，否则血流将从门静脉转向远端脾静脉，而远端脾静脉的压力已因分流而降低。这种门静脉异常循环有时可能导致门静脉血栓形成或狭窄。为防止这种不良影响，必须完全分离脾静脉（脾胰断离术）。在这方面，广泛的胃断离术无关紧要。尽管传统的DSRS一直不被看好，但我们必须认识到脾胰断离术使DSRS成为一种令人满意的技术。本文描述了食管静脉曲张选择性分流术的临床证据和理论基础。
