Jaffe V, Sandin B, Wilkins R A
Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Br J Radiol. 1990 Aug;63(752):615-9. doi: 10.1259/0007-1285-63-752-615.
Diversion of portal blood away from the liver can be accomplished in the rat by two straightforward surgical procedures: subcutaneous transposition of the spleen followed later by portal vein ligation. This experimental model has great potential value in the study of liver cell transplants, porto-systemic shunts and hepatic porto-privation. Contrast medium radiology has been used to clarify and define the model further. Splenography, achieved by direct percutaneous puncture, demonstrated the developing spleno-subcutaneous vessels. Collaterals are seen as early as 3 days and appear extensive by 21 days after transposition. Almost all emanate from the convex outer surface of the spleen and course cranially and caudally in the subcutaneous tissues to drain into the subclavian and iliac veins. The appearance of these collaterals correlates well with survival after portal vein occlusion subsequent to splenic transposition. Direct portography demonstrates that, following portal vein ligation, contrast medium is diverted away from the liver into the splenic veins, through and around the spleen, before draining into the systemic circulation through spleno-subcutaneous collaterals. These radiological studies have demonstrated the changed circulatory pathways of this model of portal diversion and have confirmed that it is the splenic veins and the spleno-subcutaneous collaterals which are fundamental to its successful outcome.
在大鼠身上，可通过两种简单的外科手术使门静脉血流改道远离肝脏：先进行脾脏皮下移位术，随后进行门静脉结扎术。该实验模型在肝细胞移植、门体分流术和肝门剥夺研究中具有巨大的潜在价值。造影剂放射学已被用于进一步阐明和界定该模型。通过直接经皮穿刺进行的脾造影显示了脾皮下血管的形成。在移位后3天即可见到侧支循环，到21天时侧支循环广泛形成。几乎所有侧支循环都发自脾脏的凸外表面，在皮下组织中向头侧和尾侧走行，汇入锁骨下静脉和髂静脉。这些侧支循环的出现与脾移位后门静脉闭塞后的生存率密切相关。直接门静脉造影显示，门静脉结扎后，造影剂从肝脏分流至脾静脉，通过脾脏并绕过脾脏，然后通过脾皮下侧支循环排入体循环。这些放射学研究证实了该门静脉分流模型循环途径的改变，并确认脾静脉和脾皮下侧支循环是其成功的关键。
