Brems J J, Hiatt J R, Klein A S, Millis J M, Colonna J O, Quinones-Baldrich W J, Ramming K P, Busuttil R W
Department of Surgery, UCLA School of Medicine.
Ann Surg. 1989 Jan;209(1):51-6. doi: 10.1097/00000658-198901000-00008.
Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two patients) and deaths (two patients) also were limited to this group. In this report, technical considerations, advantages, and disadvantages of the various shunt types are described. Management of patients with late stages of portal hypertension must include estimation of the effects of a portasystemic shunt on subsequent liver transplantation. It is concluded that portacaval shunts should be avoided in patients who may be considered for transplantation. Distal splenorenal shunts are best performed in younger patients with intractable variceal bleeding who are not expected to require transplantation in the near future. A mesocaval H-graft is the shunt of choice in patients who are current liver transplant candidates.
15例曾接受过门体分流术的患者接受了原位肝移植。分流类型为门腔分流6例，H型移植脾肾分流6例，远端脾肾分流2例，近端脾肾分流1例。门腔分流组的平均失血量和住院时间最长。再次移植（2例患者）和死亡（2例患者）也仅限于该组。在本报告中，描述了各种分流类型的技术要点、优点和缺点。门静脉高压晚期患者的管理必须包括评估门体分流对后续肝移植的影响。得出的结论是，对于可能考虑进行移植的患者，应避免行门腔分流术。远端脾肾分流术最好在近期预计不需要移植的、患有顽固性静脉曲张出血的年轻患者中进行。H型移植脾肾分流术是目前肝移植候选患者的分流术首选。
